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General NPI Number Information
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NPI Number | 1275768772
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Entity Type | Organization
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Legal Business Name | SOUTHERN FAMILY MARKETS LLC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 306 S UNIVERSITY BLVD
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City | MOBILE
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State | AL
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Zip | 36609-2909
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Country | US
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Telephone | 251-342-6595
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Fax | 251-342-1409
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Provider Business Mailing Address
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Address Line | PO BOX 8500 LOCKBOX 8531
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City | PHILADELPHIA
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State | PA
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Zip | 19178-8531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MARK TOW
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Credential |
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Telephone | 205-912-4934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 110675
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License Number State | AL
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