SOUTHERN EXPRESS PHARMACY NPI 1073078481

NPI Information

  • NPI: 1073078481
  • Provider Name: SOUTHERN EXPRESS PHARMACY
  • Classification: Pharmacy - 333600000X
  • Entity Type: Organization
  • CLIA Number: 44D2316456
  • Address: 1355 W MARKET ST
    BOLIVAR, TN
    ZIP 38008
  • Phone: (731) 472-1011

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NPI Details

SOUTHERN EXPRESS PHARMACY is a pharmacy in Bolivar, TN. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. SOUTHERN EXPRESS PHARMACY NPI is 1073078481. The provider is registered as an organization entity type.

The provider's business location address is:

1355 W MARKET ST
BOLIVAR, TN
ZIP 38008-715
Phone: (731) 472-1011
Fax: (423) 661-7602

The provider's authorized official is Elizabeth Ashley Willis .
The authorized official title is Owner/pharmacist-in-charge and has the following contact phone number (731) 472-1011.

The CLIA number assigned to this NPI record is 44D2316456 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)

The enumeration date for this NPI number is 2/10/2019 and was last updated on 8/2/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100006619OTHERTENNESSEETN BOARD OF PHARMACY LICENSE NUMBER
2Q048235MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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