Southside Drug Inc
Organization Active NPI Community/Retail Pharmacy · South Fulton, TN
NPI 1093720641 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1093720641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1133 (TN)
- Legal business name
- SOUTHSIDE DRUG INC
- Practice address
- 511 Broadway St
Southern Village S/C
South Fulton, TN 38257-2401 - Phone
- (731) 479-2262
- Fax
- (731) 479-3161
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Philip Andrews
- Title
- Owner
- Phone
- (731) 479-2262
Practitioners 1
National Provider Directory
Locations
511 Broadway St
South Fulton, TN 38257
Phone (731) 479-2262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 1133 | TN | Yes |
Addresses
Primary practice location
511 Broadway St
Southern Village S/C
South Fulton, TN 38257-2401
Mailing address
PO Box 5197
South Fulton, TN 38257-0197
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4400759 | Medicaid | TN | |
| 4400759 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other providers in South Fulton, TN
- Martin Hospital Company, LLC
- Pamela Suzette Milam
- Rice Mobile OD TN LLC
- Charles Avery Rice
- Zearle Frances Robey
- Audiene M Stoneham Nance
- Kimberly A Tilghman-Burch
- Joshua Drew Whitledge
- Virgil Dale Yates
- Nathan Yoder
All providers in South Fulton, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.