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General NPI Number Information
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NPI Number | 1184795577
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE DRUGS INC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 200 W ANDREWS ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-3839
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Country | US
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Telephone | 478-453-7227
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Fax | 478-452-9789
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Provider Business Mailing Address
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Address Line | 200 W ANDREWS ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-3839
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Country | US
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Telephone | 478-453-7227
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Fax | 478-452-9789
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Authorized Official
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Title or Position | VP
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Name | BEN BRADDY
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Credential |
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Telephone | 478-453-7227
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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 | PHRE007221
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License Number State | GA
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