# SOUTHERN REGIONAL MEDICAL CENTER - PRIME HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Regional Outpatient Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548923030
- **Authorized official:** SARAH A ROWAN PHARMD (PHARMACY SUPERVISOR)
- **Authorized official phone:** (770) 991-8066

## Contact information

- **Practice address:** 33 UPPER RIVERDALE RD SW STE 20, RIVERDALE, GA 30274-2626
- **Practice address phone:** (770) 991-8066
- **Practice address fax:** (770) 991-8072
- **Mailing address:** 33 UPPER RIVERDALE RD SW STE 20, RIVERDALE, GA 30274-2626
- **Mailing address phone:** (770) 991-8066
- **Mailing address fax:** (770) 991-8072

## Taxonomy

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

## Other

- **Enumeration date:** 10/21/2021
- **Last updated:** 10/21/2021