Organization
SOUTHSIDE FAMILY PHARMACY INC
Active
Other names
Southside Family Pharmacy, Inc,
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY BOGGS (OWNER)
(256) 413-4473
Entity
Organization
Contact information
Practice address
1250 HIGHWAY 77, SOUTHSIDE, AL 35907-0405
(256) 413-4473
(256) 413-7358
Mailing address
1250 HIGHWAY 77, SOUTHSIDE, AL 35907-0405
(256) 413-4473
(256) 413-7358
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
112170
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142548
—
AL
01
—
2137549
PK
—
Enumeration date
08/03/2006
Last updated
01/14/2021
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