Organization
SOUTHERN HEMOPHILIA INFUSION
Active
Other names
Southern Hemophilia Infusion Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN KELLEY (PRESIDENT)
(251) 937-8792
Entity
Organization
Contact information
Practice address
154 HAND AVE, BAY MINETTE, AL 36507-4825
(251) 937-8792
(251) 937-8793
Mailing address
154 HAND AVE, BAY MINETTE, AL 36507-4825
(251) 937-8792
(251) 937-8793
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
113370
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0136413
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/01/2010
Last updated
01/19/2011
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