Provider Demographics
NPI:1871367300
Name:SOUTHERN OAKS PHARMACY
Entity type:Organization
Organization Name:SOUTHERN OAKS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:OAKS
Authorized Official - Last Name:ALPHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:985-714-3480
Mailing Address - Street 1:300 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:LA
Mailing Address - Zip Code:70342-2723
Mailing Address - Country:US
Mailing Address - Phone:985-918-5511
Mailing Address - Fax:985-918-2318
Practice Address - Street 1:300 CANTON ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:LA
Practice Address - Zip Code:70342-2723
Practice Address - Country:US
Practice Address - Phone:985-918-5511
Practice Address - Fax:985-918-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy