Organization
SOUTHSIDE PHARMACY INC
Active
Other names
NICHOLS SOUTHSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MCNEILL BS (PHARMACIST OWNER)
(361) 852-8288
Entity
Organization
Contact information
Practice address
3141 GOLLIHAR RD, CORPUS CHRISTI, TX 78415-5057
(361) 852-8288
(361) 854-7269
Mailing address
3141 GOLLIHAR RD, CORPUS CHRISTI, TX 78415-5057
(361) 852-8288
(361) 854-7269
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00317
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130889
—
TX
01
—
4516552
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/20/2006
Last updated
09/28/2009
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