Southern Express Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

SOUTHERN EXPRESS PHARMACY

Practice address

1355 W Market St
Bolivar, TN 38008-1715

Phone

(731) 472-1011

Fax

(423) 661-7602

NPI assigned

Feb 10, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Elizabeth Ashley Willis, PHARMDNPI 1861868465

Title

Owner/Pharmacist-in-Charge

Phone

(731) 472-1011

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Ashley Willis, PHARMD

  • Pharmacist
  • Bolivar, TN
  • NPI 1861868465
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1073078481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 W MARKET ST",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081715",
            "telephone_number": "731-472-1011",
            "fax_number": "423-661-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 W MARKET ST",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081715",
            "telephone_number": "731-472-1011",
            "fax_number": "423-661-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN EXPRESS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-10",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ASHLEY",
        "authorized_official_title_or_position": "OWNER/PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "731-472-1011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN BOARD OF PHARMACY LICENSE NUMBER",
            "identifier": "00006619",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q048235",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.