NPIMap

Organization Active NPI

Southern Specialty Clinic, LLC

  • Pharmacy
  • Flowood, MS
National Provider Identifier
1730903113
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
SOUTHERN SPECIALTY CLINIC, LLC
Doing business as
Southern Specialty Pharmacy
Practice address
803 Liberty Rd
Flowood, MS 39232-9000
Phone
(601) 714-1967
Fax
(601) 714-1966
NPI assigned
Nov 12, 2024
Organization subpart
Yes
Parent organization
SOUTHERN SPECIALTY CLINIC, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Dr. Sharon Marie Pennington, MDNPI 1801015136
Title
Chief Executive Officer
Phone
(601) 985-8296

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

803 Liberty Rd
Flowood, MS 39232-9000

Mailing address

122 Woodlands Glen Cir
Brandon, MS 39047-7107
Phone (601) 985-8296

Other names 1

  • Southern Specialty Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250123002252 MS Part B Supplier - Pharmacy 0042747420 Practice locations: Flowood, MS

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Southern Specialty Clinic2 organizations share this tax ID, including this one
Part of
Southern Specialty Clinic

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1730903113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 WOODLANDS GLEN CIR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390477107",
            "telephone_number": "601-985-8296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 LIBERTY RD",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329000",
            "telephone_number": "601-714-1967",
            "fax_number": "601-714-1966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SPECIALTY CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN SPECIALTY CLINIC, LLC",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "601-985-8296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.

Verify at the official NPI Registry.