Organization
SOUTHSIDE DRUG INC
Active
Organization
SOUTHSIDE DRUG INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP ANDREWS (OWNER)
(731) 479-2262
Entity
Organization
Contact information
Practice address
511 BROADWAY ST, SOUTHERN VILLAGE S/C, SOUTH FULTON, TN 38257-2401
(731) 479-2262
(731) 479-3161
Mailing address
PO BOX 5197, SOUTH FULTON, TN 38257-0197
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1133
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4400759
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4400759
—
TN
Enumeration date
07/30/2006
Last updated
08/22/2020
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