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SOUTH PARK FAMILY PHARMACY LLC
NPI 1295173573
Pharmacy - Community/Retail Pharmacy in Winston-salem, NC

Active since June 10, 2013CLIA 34D2156580 · Waiver
1215 A WEST CLEMMONSVILLE ROAD, WINSTON-SALEM, NC 27127(336) 853-2744(336) 853-5915 Get Directions Write a Review

NPPES record last updated: June 18, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

About South Park Family Pharmacy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH PARK FAMILY PHARMACY LLC (NPI 1295173573), doing business as South Park Family Pharmacy, is a healthcare organization registered as a community/retail pharmacy in Winston-salem, North Carolina and active in the NPI registry since June 2013. The organization holds a CLIA Waiver certificate valid through October 21, 2026 and lists Russell Warren Patterson, Member/manager, as its authorized official.

NPPES Registry Identity

NPI1295173573
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSOUTH PARK FAMILY PHARMACY LLC
Location Address1215 A WEST CLEMMONSVILLE ROADWinston-salem, NC 27127-4790
Mailing Address1107 W Market Center DrHigh Point, NC 27260-1642 · (336) 817-6794
Phone(336) 853-2744
Fax(336) 853-5915
Organization SubpartNo
Authorized OfficialRussell Warren PattersonMember/manager · (336) 817-6794
Enumeration DateJune 10, 2013
Last NPPES UpdateJune 18, 2026
NPPES CertifiedJune 18, 2026
✔ NPI 1295173573 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedPharmacyTaxonomy 333600000X · License 11570 (NC)
1215 A WEST CLEMMONSVILLE ROAD, Winston-salem, NC 27127
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Other Names 1

Doing Business AsSouth Park Family Pharmacy

Other Identifiers 1

Medicaid1295173573NC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2156580

South Park Family Pharmacy, LLC · Winston-Salem, NC
Active · expires Oct 21, 2026
CLIA Number34D2156580
Laboratory TypePharmacy
Certificate Effective DateOctober 22, 2024
Certificate Expiration DateOctober 21, 2026
Laboratory DirectorWilliam C. Council
Laboratory Phone(336) 293-4755
Laboratory LocationSouth Park Family Pharmacy, LLC1215A W Clemmonsville Road, Winston-Salem, NC 27127
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Park Family Pharmacy LLC's NPI number?

The NPI number for South Park Family Pharmacy LLC is 1295173573. It was assigned to this organization in the NPPES registry on June 10, 2013. The provider is doing business as South Park Family Pharmacy.

Where is South Park Family Pharmacy LLC located?

South Park Family Pharmacy LLC is located at 1215 A West Clemmonsville Road, Winston-Salem, NC 27127. The listed phone number is (336) 853-2744.

What is South Park Family Pharmacy LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does South Park Family Pharmacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2156580) is associated with this NPI, valid through October 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does South Park Family Pharmacy LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 48 other insurers list South Park Family Pharmacy LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for South Park Family Pharmacy LLC was last updated on June 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.