Healthcare Provider Details

I. General information

NPI: 1336574375
Provider Name (Legal Business Name): SOUTHCARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SE 1ST AVE
TRENTON FL
32693-3219
US

IV. Provider business mailing address

PO BOX 580
MCDONOUGH GA
30253-0580
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-2240
  • Fax: 352-463-1645
Mailing address:
  • Phone: 770-474-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH27140
License Number StateFL

VIII. Authorized Official

Name: CARLY BRAND
Title or Position: PRESIDENT
Credential:
Phone: 727-344-3902