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General NPI Number Information
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NPI Number | 1093205346
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Entity Type | Organization
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Legal Business Name | SOUTHLAND PHARMACY LLC
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Dates
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Enumeration Date | 05/12/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 482 INTERSTATE DR STE K
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City | MANCHESTER
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State | TN
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Zip | 37355
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Country | US
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Telephone | 615-788-5998
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Fax | 931-954-0524
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Provider Business Mailing Address
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Address Line | 482 INTERSTATE DR SUITE K
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City | MANCHESTER
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State | TN
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Zip | 37355-3485
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Country | US
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Telephone | 931-563-0008
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Fax | 931-954-0524
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | TERRI SCIOSCIA
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Credential |
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Telephone | 931-563-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 6298
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License Number State | TN
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