Provider Demographics
NPI:1336574375
Name:SOUTHCARE PHARMACY INC
Entity Type:Organization
Organization Name:SOUTHCARE PHARMACY INC
Other - Org Name:BEST DRUGS OF TRENTON
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:
Practice Address - Street 1:405 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3219
Practice Address - Country:US
Practice Address - Phone:352-463-2240
Practice Address - Fax:352-463-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH27140333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146329OtherPK
FL011701400Medicaid