| NPI | 1184207250 |
|---|---|
| Doing Business As | SOUTHFORK PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOOTHBY Owner 817-805-7874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2022-08-26 |