Provider Demographics
NPI:1700423654
Name:SOUTHLAND LTC PHARMACY
Entity type:Organization
Organization Name:SOUTHLAND LTC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:SNOW, JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-788-5998
Mailing Address - Street 1:5727 COLCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3795
Mailing Address - Country:US
Mailing Address - Phone:615-788-5998
Mailing Address - Fax:
Practice Address - Street 1:482 INTERSTATE DR STE L
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3485
Practice Address - Country:US
Practice Address - Phone:615-788-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy