Provider Demographics
NPI:1427167477
Name:SOUTHEAST PHARMACEUTICALS, INC
Entity type:Organization
Organization Name:SOUTHEAST PHARMACEUTICALS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-897-3746
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-0415
Mailing Address - Country:US
Mailing Address - Phone:334-897-3746
Mailing Address - Fax:334-897-3716
Practice Address - Street 1:704 TROY HWY
Practice Address - Street 2:STE A
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1521
Practice Address - Country:US
Practice Address - Phone:334-897-3746
Practice Address - Fax:334-897-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110474251E00000X, 332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002728Medicaid
AL009505350Medicaid
AL510-36152OtherBCBS DME
FL106273500Medicaid
FL106273500Medicaid
AL009505350Medicaid
AL=========001OtherTRICARE
AL=========002OtherTRICARE CSP
AL009505350Medicaid