Southside Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

113810 Issued in AL

Legal business name

SOUTHSIDE PHARMACY INC

Practice address

11964 Escue Dr Ste a
Tanner, AL 35671-3680

Phone

(256) 232-6588

Fax

(256) 232-6589

NPI assigned

Oct 6, 2011

Organization subpart

No

Name

Tammy GarrettNPI 1992280366

Title

Pharmacist/President

Phone

(256) 232-6588

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

• Tammy V Garrett

  • Pharmacist
  • Tanner, AL
  • NPI 1992280366
  NPD (past) Authorized official
• Scott J Garrett, PHARMD

  • Pharmacist
  • Tanner, AL
  • NPI 1215774625
  NPD

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

• Southside Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 27, 2016.

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1548544752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11964 ESCUE DR",
            "address_2": "SUITE A",
            "city": "TANNER",
            "state": "AL",
            "postal_code": "356713679",
            "telephone_number": "256-232-6588",
            "fax_number": "256-232-6589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11964 ESCUE DR STE A",
            "city": "TANNER",
            "state": "AL",
            "postal_code": "356713680",
            "telephone_number": "256-232-6588",
            "fax_number": "256-232-6589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "GARRETT",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "PHARMACIST/PRESIDENT",
        "authorized_official_telephone_number": "256-232-6588"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132353",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134219",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Traci McLin
• Scott Allen Parvin, D.M.D.
• Tracy L Pool, MD
• Chelsea Poss, CRNP
• Stanley Farrell Smallwood, CRNP-APRN-BC
• Tammy V Garrett
• Tanner Community Care
• Tanner Medical Clinic LLC

• All providers in Tanner, AL
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; 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.