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)	05157/11.1	MS

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

General Provider Information

NPI Number	:	1366536856
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	:	2002 HWY. 45 NORTH
Second Line	:	SUITE 1
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2247
Country	:	US
Telephone Number	:	866-366-3394
Fax Number	:	662-327-6294

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/16/2024

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Directions to “SOUTHERN PHARMACEUTICAL CORPORATION ” Practice Location

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