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General NPI Number Information
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NPI Number | 1831115781
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Entity Type | Organization
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Legal Business Name | SOUTHERN HOME CARE
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 8865 FIRST INDUSTRIAL DR
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1919
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Country | US
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Telephone | 662-342-8527
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Fax | 662-280-3708
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Provider Business Mailing Address
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Address Line | PO BOX 793
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City | CHARLESTON
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State | MS
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Zip | 38921-0793
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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 | VP OF OPS
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Name | CLIFTON GANT
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Credential |
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Telephone | 662-342-8527
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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 | 926
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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