# SOUTHERN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTHERN PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073528683
- **Authorized official:** NATHALIE JONES (PIC)
- **Authorized official phone:** (773) 927-0270

## Contact information

- **Practice address:** 4829 S ASHLAND AVE, CHICAGO, IL 60609-4234
- **Practice address phone:** (773) 927-0270
- **Practice address fax:** (773) 927-6128
- **Mailing address:** 4829 S ASHLAND AVE, CHICAGO, IL 60609-4234
- **Mailing address phone:** (773) 927-0270
- **Mailing address fax:** (773) 927-6128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054009286 | IL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 09/10/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2020887 | PK | — |