| NPI | 1821159906 |
|---|---|
| Doing Business As | SOUTHSIDE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MARK FETCENKO COO Officer 832-553-1301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 25057) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-07-26 |