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Organization
SOUTHERN HEMOPHILIA INFUSION
Active
Organization
SOUTHERN HEMOPHILIA INFUSION
Active
Other names
Southern Hemophilia Infusion Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN KELLEY (PRESIDENT)
(251) 937-8792
Entity
Organization
Contact information
Practice address
154 HAND AVE, BAY MINETTE, AL 36507-4825
(251) 937-8792
(251) 937-8793
Mailing address
154 HAND AVE, BAY MINETTE, AL 36507-4825
(251) 937-8792
(251) 937-8793
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
Primary
113370
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0136413
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/01/2010
Last updated
01/19/2011
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