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General NPI Number Information
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NPI Number | 1972696334
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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 | 10/30/2009
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Provider Practice Location Address
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Address Line | 1025 E SPRING ST
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City | MONROE
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State | GA
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Zip | 30655-2470
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Country | US
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Telephone | 770-267-4214
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Fax | 770-207-9663
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Provider Business Mailing Address
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Address Line | PO BOX 8500 LOCKBOX 8531
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City | PHILADELPHIA
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State | PA
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Zip | 19178-8531
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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 | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE008574
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License Number State | GA
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