Provider Demographics
NPI:1548515620
Name:SOUTHERN RX LLC
Entity type:Organization
Organization Name:SOUTHERN RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MORDIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:954-298-1736
Mailing Address - Street 1:10131 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4327
Mailing Address - Country:US
Mailing Address - Phone:954-722-8111
Mailing Address - Fax:954-722-8222
Practice Address - Street 1:10131 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-4327
Practice Address - Country:US
Practice Address - Phone:954-722-8111
Practice Address - Fax:954-722-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy