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General NPI Number Information
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NPI Number | 1548515620
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Entity Type | Organization
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Legal Business Name | SOUTHERN RX LLC
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 10131 W COMMERCIAL BLVD
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City | SUNRISE
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State | FL
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Zip | 33351-4327
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Country | US
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Telephone | 954-722-8111
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Fax | 954-722-8222
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Provider Business Mailing Address
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Address Line | 10131 W COMMERCIAL BLVD
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City | SUNRISE
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State | FL
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Zip | 33351-4327
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Country | US
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Telephone | 954-722-8111
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Fax | 954-722-8222
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. JONATHAN ALAN MORDIS
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Credential | PHARM D
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Telephone | 954-298-1736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 |
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License Number State |
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