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Organization
SOUTHSIDE FAMILY PHARMACY INC
Active
Organization
SOUTHSIDE FAMILY PHARMACY INC
Active
Other names
Southside Family Pharmacy, Inc,
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY BOGGS (OWNER)
(256) 413-4473
Entity
Organization
Contact information
Practice address
1250 HIGHWAY 77, SOUTHSIDE, AL 35907-0405
(256) 413-4473
(256) 413-7358
Mailing address
1250 HIGHWAY 77, SOUTHSIDE, AL 35907-0405
(256) 413-4473
(256) 413-7358
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
112170
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142548
—
AL
01
—
2137549
PK
—
Enumeration date
08/03/2006
Last updated
01/14/2021
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