Provider Demographics
NPI:1467608075
Name:SOUTHERN MERIDIAN INC
Entity Type:Organization
Organization Name:SOUTHERN MERIDIAN INC
Other - Org Name:SANTA ROSA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-622-3313
Mailing Address - Street 1:19 TOWN CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-0700
Mailing Address - Country:US
Mailing Address - Phone:850-622-3313
Mailing Address - Fax:850-622-3255
Practice Address - Street 1:19 TOWN CENTER LOOP
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-0700
Practice Address - Country:US
Practice Address - Phone:850-622-3313
Practice Address - Fax:850-622-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy