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Organization
SOUTHEAST FOODS, INC.
Active
Organization
SOUTHEAST FOODS, INC.
Active
Other names
COUNTY MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DEDMON (CFO)
(318) 388-1884
Entity
Organization
Contact information
Practice address
3111 HIGHWAY 80 E, PEARL, MS 39208-3503
(601) 932-5337
(601) 932-7952
Mailing address
3111 HIGHWAY 80 E, PEARL, MS 39208-3503
(601) 932-5337
(601) 932-7952
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
03618012
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330610
—
MS
01
—
2520674
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/02/2007
Last updated
03/02/2010
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