MEDICARE: SOUTHERN PHARMACEUTICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	14931/11.1	MS
2	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053406165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN PHARMACEUTICAL CORPORATION

Provider Business Mailing Address
First Line	:	1019 TOWN DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-9114
Country	:	US
Telephone Number	:	859-441-8876
Fax Number	:

Provider Business Practice Location Address
First Line	:	7458 DOGWOOD PARK DR
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-6470
Country	:	US
Telephone Number	:	826-348-1100
Fax Number	:	682-348-1102

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY J CRAWFORD
Credential	:
Telephone Number	:	859-441-8876

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/16/2024

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Directions to “SOUTHERN PHARMACEUTICAL CORPORATION ” Practice Location

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