Organization
SOUTHERN PHARMACY SERVICES
Active
Other names
Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDY FREED (OWNER/PHARMACIST)
(337) 783-9084
Entity
Organization
Contact information
Practice address
704 N PARKERSON AVE, CROWLEY, LA 70526-4355
(337) 783-9084
(337) 783-9085
Mailing address
704 N PARKERSON AVE, CROWLEY, LA 70526-4355
(337) 783-9084
(337) 783-9085
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
6171
LA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
6171
LA
3336L0003X
Long Term Care Pharmacy
6171
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235253
—
LA
01
—
5DK78
MEDICARE PTAN
LA
Enumeration date
07/02/2009
Last updated
08/18/2016
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