# SOUTHERN HEMOPHILIA INFUSION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Hemophilia Infusion Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720301054
- **Authorized official:** JONATHAN KELLEY (PRESIDENT)
- **Authorized official phone:** (251) 937-8792

## Contact information

- **Practice address:** 154 HAND AVE, BAY MINETTE, AL 36507-4825
- **Practice address phone:** (251) 937-8792
- **Practice address fax:** (251) 937-8793
- **Mailing address:** 154 HAND AVE, BAY MINETTE, AL 36507-4825
- **Mailing address phone:** (251) 937-8792
- **Mailing address fax:** (251) 937-8793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336H0001X | Home Infusion Therapy Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | 113370 | AL | Yes |

## Other

- **Enumeration date:** 03/01/2010
- **Last updated:** 01/19/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0136413 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |