Healthcare Provider Details

I. General information

NPI: 1265831978
Provider Name (Legal Business Name): SOUTHERN HILLS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N UNIVERSITY DR
PLANTATION FL
33322-4111
US

IV. Provider business mailing address

1739 N UNIVERSITY DR
PLANTATION FL
33322-4111
US

V. Phone/Fax

Practice location:
  • Phone: 850-590-2622
  • Fax: 954-990-8125
Mailing address:
  • Phone: 850-590-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH29133
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARVEY PINKSTON
Title or Position: CEO
Credential:
Phone: 850-590-2622