Provider Information for 1154414522
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SOUTHERN FAMILY MARKETS LLC
Other Names:Doing Business As:SOUTHERN FAMILY MARKETOrganization Subpart: NO
NPI: 1154414522
Last Updated: 2020-08-22
Certification Date:
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Details
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NPI | 1154414522 | ||||||||||||
Enumeration Date | 2006-09-30 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
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 | ||||||||||||
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