Provider Demographics
NPI:1063744902
Name:SOUTHERN, BARRY WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:WILLIAM
Last Name:SOUTHERN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MIDDLEBURY WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8688
Mailing Address - Country:US
Mailing Address - Phone:336-288-0025
Mailing Address - Fax:
Practice Address - Street 1:422 GALLIMORE DAIRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9725
Practice Address - Country:US
Practice Address - Phone:336-393-0555
Practice Address - Fax:901-435-4592
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08156183500000X
TN13022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist