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Organization
SOUTHEAST PHARMACY LLC
Active
Organization
SOUTHEAST PHARMACY LLC
Active
Other names
Southeast Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL JOHNSON (OWNER)
(601) 938-5323
Entity
Organization
Contact information
Practice address
2402 LONG CREEK ROAD, MERIDIAN, MS 39301
(601) 483-5600
Mailing address
6125 ZERO RD, MERIDIAN, MS 39301-8655
(601) 483-5600
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
14553
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155235
PK
—
Enumeration date
11/20/2015
Last updated
03/08/2016
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