Organization
SOUTHERN EXPRESS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH ASHLEY WILLIS PHARMD (OWNER/PHARMACIST-IN-CHARGE)
(731) 472-1011
Entity
Organization
Contact information
Practice address
1355 W MARKET ST, BOLIVAR, TN 38008-1715
(731) 472-1011
(423) 661-7602
Mailing address
1355 W MARKET ST, BOLIVAR, TN 38008-1715
(731) 472-1011
(423) 661-7602
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00006619
TN BOARD OF PHARMACY LICENSE NUMBER
TN
05
—
Q048235
—
TN
Enumeration date
02/10/2019
Last updated
08/02/2019
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