Provider Demographics
NPI:1891340485
Name:SOUTHERN RX LLC
Entity type:Organization
Organization Name:SOUTHERN RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHAPMAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-948-5208
Mailing Address - Street 1:6935 S SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2465
Mailing Address - Country:US
Mailing Address - Phone:770-948-5208
Mailing Address - Fax:770-948-5949
Practice Address - Street 1:6935 S SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2465
Practice Address - Country:US
Practice Address - Phone:770-948-5208
Practice Address - Fax:770-948-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy