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General NPI Number Information
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NPI Number | 1477189553
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Entity Type | Organization
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Legal Business Name | 41 SOUTH SUPPLY INC
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 214 S MAIN ST
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City | FAIRMONT
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State | NC
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Zip | 28340-1904
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Country | US
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Telephone | 910-535-4190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1085
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City | LUMBERTON
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State | NC
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Zip | 28359-1085
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Country | US
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Telephone | 910-535-4190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON FOIL
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Credential | RPH
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Telephone | 910-671-9000
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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 |
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License Number State |
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