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General NPI Number Information
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NPI Number | 1720439532
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Entity Type | Organization
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Legal Business Name | SOUTHCARE PHARMACY INC.
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 6450 38TH AVE N STE A1
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-1645
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Country | US
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Telephone | 727-344-3902
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Fax | 727-343-1356
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Provider Business Mailing Address
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Address Line | PO BOX 580
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City | MCDONOUGH
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State | GA
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Zip | 30253-0580
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Country | US
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Telephone | 770-474-7693
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLY BRAND
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Credential |
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Telephone | 727-344-3902
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH25055
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License Number State | FL
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