Active NPI
Southland Pharmacy LLC
- Community/Retail Pharmacy
- Manchester, TN
National Provider Identifier
1093205346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 6298
- Legal business name
- SOUTHLAND PHARMACY LLC
- Practice address
- 482 Interstate Dr Ste K
Manchester, TN 37355 - Phone
- (615) 788-5998
- Fax
- (931) 954-0524
- NPI assigned
- May 12, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Terri Scioscia
- Title
- Pharmacist in Charge
- Phone
- (931) 563-0008
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 6298 | TN | Primary |
Addresses
Primary practice location
482 Interstate Dr Ste K
Manchester, TN 37355
Mailing address
482 Interstate Dr
Suite K
Manchester, TN 37355-3485
Phone (931) 563-0008
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2177446 | Other | PK | |
| Q036024 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240104002142 | TN | Part B Supplier - Pharmacy | 7810348794 | Practice locations: Manchester, TN |
National Provider Directory
National Provider Directory- Tax ID family
- Southland Pharmacy LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Manchester, TN
- NPI 1760144745
Locations
482 Interstate Dr
Ste K
Manchester, TN 37355
Phone (615) 730-8626
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526083200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1532649600000",
"number": "1093205346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "482 INTERSTATE DR",
"address_2": "SUITE K",
"city": "MANCHESTER",
"state": "TN",
"postal_code": "373553485",
"telephone_number": "931-563-0008",
"fax_number": "931-954-0524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "482 INTERSTATE DR STE K",
"city": "MANCHESTER",
"state": "TN",
"postal_code": "37355",
"telephone_number": "615-788-5998",
"fax_number": "931-954-0524"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHLAND PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-05-12",
"last_updated": "2018-07-27",
"status": "A",
"authorized_official_last_name": "SCIOSCIA",
"authorized_official_first_name": "TERRI",
"authorized_official_title_or_position": "PHARMACIST IN CHARGE",
"authorized_official_telephone_number": "931-563-0008"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TN",
"license": "6298",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2177446",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q036024",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.