Healthcare Provider Details

I. General information

NPI: 1871367300
Provider Name (Legal Business Name): SOUTHERN OAKS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CANTON ST
BERWICK LA
70342-2723
US

IV. Provider business mailing address

300 CANTON ST
BERWICK LA
70342-2723
US

V. Phone/Fax

Practice location:
  • Phone: 985-918-5511
  • Fax: 985-918-2318
Mailing address:
  • Phone: 985-918-5511
  • Fax: 985-918-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY OAKS ALPHA
Title or Position: OWNER
Credential: PHARM.D.
Phone: 985-714-3480