SOUTHSIDE DRUG INC (NPI# 1093720641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093720641 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE DRUG INC |
| Practice Address |
511 Broadway St Southern Village S/c South Fulton TN 38257-2401 |
| Mailing Address |
Po Box 5197 South Fulton TN 38257-0197 |
| Practice Telephone | 7314792262 |
| Practice Fax Number | 7314793161 |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | PHILIP ANDREWS (OWNER) |
| Authorized Official Telephone | 7314792262 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
1133 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4400759 | 01 | |
| TN | 4400759 | 05 |
| Street Address |
511 BROADWAY ST SOUTHERN VILLAGE S/C |
| City | SOUTH FULTON |
| State | TN |
| Zip Code | 38257-2401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962421487 | Philip Andrews | Pharmacist | 511 Broadway St, South Fulton, TN 38257-2401 | 2006-07-18 |
| 1396888996 | Charles Wade Andrews I | Pharmacist | 511 Broadway St, South Fulton, TN 38257 | 2007-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275882565 | Katherine Hames Cummings | Physician Assistant | 209 West State Line Rd, South Fulton, TN 38257 | 2012-09-03 |
| 1134275019 | Pamela Suzette Milam | Nurse Practitioner | 209 West State Line Rd., South Fulton, TN 38257 | 2007-01-25 |
| 1740268531 | Charles Avery Rice | Optometrist | 207 West State Line, South Fulton, TN 38257 | 2006-01-03 |
| 1932382850 | Dr Charles A Rice Od PC | Optometrist | 207 W State Line St, South Fulton, TN 38257-2015 | 2007-12-13 |
| 1982829065 | Audiene M Stoneham Nance | Developmental Therapist | 311 Holmes St, South Fulton, TN 38257-2139 | 2007-04-16 |
| 1306923537 | William Thomas Byars Jr. | Optometrist | 300 Broadway St, South Fulton, TN 38257-2165 | 2006-11-01 |
| 1699315549 | Zearle Frances Robey | Technician | 407 Harris Drive, South Fulton, TN 38257-2325 | 2020-01-08 |
| 1326686064 | Integrity-park Terrace, LLC | Assisted Living Facility | 712 Broadway St, South Fulton, TN 38257-2406 | 2019-12-12 |
| 1154769297 | Elaine Leslie Barnes | Early Intervention Provider Agency | 516 Oliver Dr, South Fulton, TN 38257-2450 | 2013-06-11 |
| 1457847782 | Rice Mobile Od Tn LLC | Optometrist | 304 Orchard Dr, South Fulton, TN 38257-2456 | 2018-07-10 |
| Find all providers in zip 38257 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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|---|---|---|---|---|
| 1033718317 | Rockvegas Enterprises Inc Dba Gateway Pharmacy | Pharmacy | 524 N Gateway Ave, Rockwood, TN 37854-2353 | 2020-10-19 |
| 1124626767 | Knoxville Rx Corp | Pharmacy | 10205 Kingston Pike Ste E, Knoxville, TN 37922-3285 | 2020-10-15 |
| 1073126181 | Off Center, LLC | Pharmacy | 910 Overton Plz, Livingston, TN 38570-1753 | 2020-08-28 |
| 1316557937 | Guardian Pharmacy of Tennessee Three, LLC | Pharmacy | 661 E Lane St Ste B, Shelbyville, TN 37160-3437 | 2020-08-07 |
| 1447860507 | Fph LLC | Pharmacy | 2200 N Central Ave, Humbolt, TN 38343 | 2020-08-04 |
| 1366069965 | Plaza Pharmacy LLC | Pharmacy | 3024 Covington Pike Ste 5, Memphis, TN 38128-5043 | 2020-06-30 |
| 1548886104 | Tumlin Rx, LLC | Pharmacy | 104 E Main Blvd, Church Hill, TN 37642-3724 | 2020-06-19 |
| 1366065278 | Life Well Pharmacy, LLC | Pharmacy | 2408 Susannah St Ste 3, Johnson City, TN 37601-1765 | 2020-05-27 |
| 1699398602 | Walgreen Co | Pharmacy | 262 Danny Thomas Pl Ste 100rx, Memphis, TN 38105-3678 | 2020-05-26 |
| 1053931881 | Jones & Joslin, Pllc | Pharmacy | 4249 Highway 411 Ste 5, Madisonville, TN 37354-1544 | 2020-04-22 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH FULTON |
| Zip Code | 38257 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.