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General NPI Number Information
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NPI Number | 1437466968
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Entity Type | Organization
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Legal Business Name | SOUTHERN STATES PHARMACY
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 4047 OKEECHOBEE BLVD SUITE #120
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3239
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Country | US
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Telephone | 561-487-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 4047 OKEECHOBEE BLVD SUITE #120
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3239
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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 | OWNER
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Name | OMAR ONESTA HARVEY
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Credential |
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Telephone | 561-487-3808
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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 | PH24848
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License Number State | FL
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