# SOUTHSIDE FAMILY PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southside Family Pharmacy, Inc,
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396753927
- **Authorized official:** TRACY BOGGS (OWNER)
- **Authorized official phone:** (256) 413-4473

## Contact information

- **Practice address:** 1250 HIGHWAY 77, SOUTHSIDE, AL 35907-0405
- **Practice address phone:** (256) 413-4473
- **Practice address fax:** (256) 413-7358
- **Mailing address:** 1250 HIGHWAY 77, SOUTHSIDE, AL 35907-0405
- **Mailing address phone:** (256) 413-4473
- **Mailing address fax:** (256) 413-7358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 112170 | AL | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 01/14/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 142548 | — | AL |
| 01 | — | 2137549 | PK | — |