Provider Demographics
NPI:1740479930
Name:SOUTHERN FAMILY PHARMACY INC
Entity type:Organization
Organization Name:SOUTHERN FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMASZEWSKLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-464-5343
Mailing Address - Street 1:9432 KATY FWY
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6349
Mailing Address - Country:US
Mailing Address - Phone:713-464-5343
Mailing Address - Fax:713-935-0649
Practice Address - Street 1:9432 KATY FWY
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6349
Practice Address - Country:US
Practice Address - Phone:713-464-5343
Practice Address - Fax:713-935-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0002X, 3336S0011X
TX198603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4517554OtherNCPDP PROVIDER IDENTIFICATION NUMBER