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General NPI Number Information
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NPI Number | 1881787257
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Entity Type | Organization
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Legal Business Name | SOUTHERN FAMILY MARKETS LLC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2050 HILLSBORO BLVD
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City | MANCHESTER
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State | TN
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Zip | 37355-7306
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Country | US
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Telephone | 931-723-1849
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Fax | 931-723-4641
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Provider Business Mailing Address
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Address Line | 2050 HILLSBORO BLVD
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City | MANCHESTER
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State | TN
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Zip | 37355-7306
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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 | DIRECTOR OF PHARMACY
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Name | MARK TOW
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Credential |
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Telephone | 205-912-4234
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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 | 0000003474
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License Number State | TN
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