Southgate Pharmacy
LBN: Southgate Pharmacy Llc
Southgate Pharmacy is an health care organization with primary practice located at 2709 W Broadway Ave , Moses Lake WA 98837-2904. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Southgate Pharmacy Llc can be contacted via phone (509) 765-9332, or through Olaniyan, Lateef Ajani via phone (509) 765-9332.
Contact Information
Primary practice address
2709 W Broadway Ave
Moses Lake WA 98837-2904
Phone: (509) 765-9332
Fax: (509) 765-4761
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | PHAR.CF.60118893 | Washington |
| Suppliers / Long Term Care Pharmacy | 3336L0003X |
Profile Details
| NPI number | 1427381136 |
|---|---|
| LBN Legal business name | Southgate Pharmacy Llc |
| DBA Doing business as | Southgate Pharmacy |
| Authorized official | Olaniyan, Lateef Ajani PHARM D |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 14th, 2009 |
| Last updated | Oct 23rd, 2019 - about 5 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427381136 | NPPES |
| Other | 2122066 | PK | |
| MEDICAID | 6032577 | PK |
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