Provider Demographics
NPI:1568142099
Name:SOUTHERN CANCER CENTER, PC
Entity Type:Organization
Organization Name:SOUTHERN CANCER CENTER, PC
Other - Org Name:COASTAL PHARMACY SPRINGHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-625-6896
Mailing Address - Street 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:
Practice Address - Street 1:3719 DAUPHIN ST.
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1769
Practice Address - Country:US
Practice Address - Phone:251-607-5061
Practice Address - Fax:251-607-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy