Provider Demographics
NPI:1518456623
Name:SOUTHERN PHARMACY INC
Entity Type:Organization
Organization Name:SOUTHERN PHARMACY INC
Other - Org Name:SOUTHERN PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUFOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-918-9300
Mailing Address - Street 1:1301 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1504
Mailing Address - Country:US
Mailing Address - Phone:347-918-9300
Mailing Address - Fax:347-918-9344
Practice Address - Street 1:1301 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1504
Practice Address - Country:US
Practice Address - Phone:347-918-9300
Practice Address - Fax:347-918-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0365803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177711OtherPK