Provider Demographics
NPI:1336232792
Name:SOUTHERN FAMILY MARKETS LLC
Entity type:Organization
Organization Name:SOUTHERN FAMILY MARKETS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-912-4234
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCKBOX 8531
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-8531
Mailing Address - Country:US
Mailing Address - Phone:256-353-6303
Mailing Address - Fax:256-355-5562
Practice Address - Street 1:2019 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6500
Practice Address - Country:US
Practice Address - Phone:256-353-6303
Practice Address - Fax:256-355-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1107523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0133239OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL100003628Medicaid
0133239OtherNCPDP PROVIDER IDENTIFICATION NUMBER