Provider Demographics
NPI:1427079490
Name:NORTHSIDE FAMILY PHARMACY INC
Entity type:Organization
Organization Name:NORTHSIDE FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-985-4263
Mailing Address - Street 1:3920 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:BATTLEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27809-9038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3920 BISHOP RD
Practice Address - Street 2:
Practice Address - City:BATTLEBORO
Practice Address - State:NC
Practice Address - Zip Code:27809-9038
Practice Address - Country:US
Practice Address - Phone:252-985-4263
Practice Address - Fax:252-985-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09197333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3404821OtherOTHER ID NUMBER-COMMERCIAL NUMBER