Provider Demographics
NPI:1063077881
Name:SOUTHSIDE MASTER LLC
Entity type:Organization
Organization Name:SOUTHSIDE MASTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:6330 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 700, 7TH FLOOR
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2928
Mailing Address - Country:US
Mailing Address - Phone:713-660-8888
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:755 MOUNT VERNON HWY
Practice Address - Street 2:SUITE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4292
Practice Address - Country:US
Practice Address - Phone:470-377-4054
Practice Address - Fax:470-377-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy