Healthcare Provider Details

I. General information

NPI: 1275768772
Provider Name (Legal Business Name): SOUTHERN FAMILY MARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S UNIVERSITY BLVD
MOBILE AL
36609-2909
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX 8531
PHILADELPHIA PA
19178-8531
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-6595
  • Fax: 251-342-1409
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number110675
License Number StateAL

VIII. Authorized Official

Name: MARK TOW
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 205-912-4934