Provider Demographics
NPI:1700019700
Name:SOUTHER, MARY LEE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEE
Last Name:SOUTHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-2255
Mailing Address - Country:US
Mailing Address - Phone:336-835-6407
Mailing Address - Fax:336-526-8329
Practice Address - Street 1:450 WINSTON RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-2255
Practice Address - Country:US
Practice Address - Phone:336-835-6407
Practice Address - Fax:336-526-8329
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist