Provider Demographics
NPI:1467755488
Name:SOUTHCARE PHARMACY INC
Entity Type:Organization
Organization Name:SOUTHCARE PHARMACY INC
Other - Org Name:SOUTHCARE PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-344-3902
Mailing Address - Street 1:106 ROCK QUARRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3768
Mailing Address - Country:US
Mailing Address - Phone:770-474-7693
Mailing Address - Fax:770-692-8244
Practice Address - Street 1:6450 38TH AVE N STE 110
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1649
Practice Address - Country:US
Practice Address - Phone:727-344-3902
Practice Address - Fax:727-344-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH250553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5703093OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5703093OtherNCPDP PROVIDER IDENTIFICATION NUMBER