Provider Demographics
NPI:1679123673
Name:SOUTHLANDS ENTERPRISES INC
Entity type:Organization
Organization Name:SOUTHLANDS ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NJERU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:352-283-9094
Mailing Address - Street 1:6562 SW 90TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8569
Mailing Address - Country:US
Mailing Address - Phone:352-283-9094
Mailing Address - Fax:
Practice Address - Street 1:25340 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4252
Practice Address - Country:US
Practice Address - Phone:352-660-2115
Practice Address - Fax:352-660-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy