MEDICARE: SOUTHERN FAMILY MARKETS, LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1164668323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN FAMILY MARKETS, LLC

Provider Business Mailing Address
First Line	:	800 LAKESHORE PKWY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-4447
Country	:	US
Telephone Number	:	205-912-4934
Fax Number	:	205-912-4919

Provider Business Practice Location Address
First Line	:	800 LAKESHORE PKWY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-4447
Country	:	US
Telephone Number	:	205-912-4934
Fax Number	:	205-912-4919

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MR. MARK R TOW
Credential	:	RPH
Telephone Number	:	205-912-4934

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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