MEDICARE: SOUTHERN DRUGS, 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	183500000X	Pharmacist	E-08239	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2515421	OTHER	MS	NCPDP

General Provider Information

NPI Number	:	1528165248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN DRUGS, INC

Provider Business Mailing Address
First Line	:	3654 NEW HOPE RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-8521
Country	:	US
Telephone Number	:	662-328-8028
Fax Number	:	662-328-3149

Provider Business Practice Location Address
First Line	:	3654 NEW HOPE RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-8521
Country	:	US
Telephone Number	:	662-328-8028
Fax Number	:	662-328-3149

Authorized Official
Title or Position	:	VICE PRESIDENT/PHARMACIST
Name	:	MRS. AMY C WEATHERS
Credential	:	R.PH.
Telephone Number	:	662-328-8028

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHERN DRUGS, INC ” Practice Location

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