| NPI | 1194186056 |
|---|---|
| Doing Business As | SOUTHSIDE SPECIALTY PHARMACY |
| Entity Type | Organization |
| Authorized Contact | IHAB HERRAKA President 479-242-2888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: AR AR20829) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AR AR20829) |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AR AR20829) | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2016-03-18 |