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General NPI Number Information
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NPI Number | 1518054709
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Entity Type | Organization
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Legal Business Name | SOUTHERN RX
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 1033 ANDRE ST
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City | NEW IBERIA
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State | LA
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Zip | 70563
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Country | US
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Telephone | 337-365-1411
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Fax | 337-365-0932
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Provider Business Mailing Address
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Address Line | 1033 ANDRE ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-2161
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Country | US
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Telephone | 337-365-1411
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Fax | 337-365-0932
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Authorized Official
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Title or Position | OWNER
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Name | RAHUL PATEL
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Credential |
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Telephone | 337-365-1411
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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 | PHY007503IR
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHY007503IR
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY007503IR
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License Number State | LA
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