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Organization
SOUTHERN HOME CARE
Active
Organization
SOUTHERN HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFTON GANT (VP OF OPS)
(662) 342-8527
Entity
Organization
Contact information
Practice address
8865 FIRST INDUSTRIAL DR, SOUTHAVEN, MS 38671-1919
(662) 342-8527
(662) 280-3708
Mailing address
PO BOX 793, CHARLESTON, MS 38921-0793
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
926
MS
3336S0011X
Specialty Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00045117
—
MS
01
—
2586432
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4581871
—
MS
Enumeration date
07/14/2006
Last updated
09/11/2025
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