MEDICARE: SOUTHERN PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	054009286	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2020887	OTHER		PK

General Provider Information

NPI Number	:	1073528683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN PHARMACY INC

Provider Business Mailing Address
First Line	:	4829 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4234
Country	:	US
Telephone Number	:	773-927-0270
Fax Number	:	773-927-6128

Provider Business Practice Location Address
First Line	:	4829 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4234
Country	:	US
Telephone Number	:	773-927-0270
Fax Number	:	773-927-6128

Authorized Official
Title or Position	:	PIC
Name	:	NATHALIE JONES
Credential	:
Telephone Number	:	773-927-0270

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	09/10/2014

Similar Medicare Providers

1912997743 — DR. AHMED SHAFI M.D.
Practice Location Address:

4829 S ASHLAND AVE
CHICAGO, IL
60609-4234

Practice Phone: 773-927-2714
Practice Fax: 773-927-2716

1750364014 — MOHAMMAD ZAFFAR DDS
Practice Location Address:

4829 SOUTH ASHLAND AVE
CHICAGO, IL
60609-4234

Practice Phone: 773-927-6644
Practice Fax:

1174660302 — LORRAINE E SHAFFER R.PH.
Practice Location Address:

939 W GUNNISON ST , SUITE 3E
CHICAGO, IL
60640-4234

Practice Phone: 773-459-3700
Practice Fax:

1265628762 — DR. SALEEM AHMAD OD
Practice Location Address:

4234 S ARCHER AVE
CHICAGO, IL
60632-2550

Practice Phone: 773-254-6800
Practice Fax:

1841428547 — HABILITATIVE SYSTEMS, INC.
Practice Location Address:

4234 W POTOMAC AVE
CHICAGO, IL
60651

Practice Phone: 773-278-6171
Practice Fax: 773-854-8300

1518702752 — JAZMIN ALCAZAR
Practice Location Address:

4356 W 25TH ST
CHICAGO, IL
60623-4234

Practice Phone: 312-262-8075
Practice Fax:

Directions to “SOUTHERN PHARMACY INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.