Organization
SOUTHERN PHARMACY INC
Active
Other names
SOUTHERN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NATHALIE JONES (PIC)
(773) 927-0270
Entity
Organization
Contact information
Practice address
4829 S ASHLAND AVE, CHICAGO, IL 60609-4234
(773) 927-0270
(773) 927-6128
Mailing address
4829 S ASHLAND AVE, CHICAGO, IL 60609-4234
(773) 927-0270
(773) 927-6128
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054009286
IL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020887
PK
—
Enumeration date
07/30/2006
Last updated
09/10/2014
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