Healthcare Provider Details

I. General information

NPI: 1295268985
Provider Name (Legal Business Name): SOUTHERN PHARMACY CLINICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 DIJON AVE
OCEAN SPRINGS MS
39564-8520
US

IV. Provider business mailing address

3224 DIJON AVE
OCEAN SPRINGS MS
39564-8520
US

V. Phone/Fax

Practice location:
  • Phone: 228-363-0500
  • Fax: 800-651-3566
Mailing address:
  • Phone: 228-363-0500
  • Fax: 800-651-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAMMY NERON
Title or Position: PARTNER CEO
Credential:
Phone: 228-363-0500