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Provider Information for 1154414522


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SOUTHERN FAMILY MARKETS LLC

Other Names:  
Doing Business As: 
SOUTHERN FAMILY MARKET

Organization Subpart: NO

NPI: 1154414522
Last Updated: 2020-08-22
Certification Date:

Details

NameValue
NPI1154414522
Enumeration Date2006-09-30
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: MARK TOW
Title: DIRECTOR OF PHARMACY
Phone: 2059124234
Mailing Address 1906 SHADY BROOK ST
COLUMBIA, TN 38401-3989
United States

Phone: | Fax:
 
Primary Practice Address 1906 SHADY BROOK ST
COLUMBIA, TN 38401-3989
United States

Phone: 931-388-4793 | Fax:931-388-4798
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)4438900Other ID Number-Commercial Number
MEDICAIDTN4438900
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy TN0000001568
No 3336C0003X - Pharmacy - Community/Retail Pharmacy