Provider Demographics
NPI:1952530248
Name:SOUTHERN HEALTH AND WELLNESS, INC
Entity type:Organization
Organization Name:SOUTHERN HEALTH AND WELLNESS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LOMAX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-275-9496
Mailing Address - Street 1:3001 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7432
Mailing Address - Country:US
Mailing Address - Phone:870-275-9496
Mailing Address - Fax:870-931-0992
Practice Address - Street 1:730 GREENWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LEPANTO
Practice Address - State:AR
Practice Address - Zip Code:72354-3215
Practice Address - Country:US
Practice Address - Phone:870-475-2617
Practice Address - Fax:870-475-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR039533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0423210OtherNCPDP
ARAR15744OtherARKANSAS PHARMACY LICENSE
AR178305407Medicaid
ARAR15744OtherARKANSAS PHARMACY LICENSE
FL1528302OtherDEA