MEDICARE: SOUTHERN RX

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	3336L0003X	Long Term Care Pharmacy

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

General Provider Information

NPI Number	:	1710671524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN RX

Provider Business Mailing Address
First Line	:	1033 ANDRE ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2161
Country	:	US
Telephone Number	:	337-365-1411
Fax Number	:	337-365-0932

Provider Business Practice Location Address
First Line	:	1033 ANDRE ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2161
Country	:	US
Telephone Number	:	337-365-1411
Fax Number	:	337-365-0932

Authorized Official
Title or Position	:	OWNER
Name	:	RAHUL PATEL
Credential	:
Telephone Number	:	337-365-1411

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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Directions to “SOUTHERN RX ” Practice Location

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