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SOUTHERN EXPRESS PHARMACY
NPI 1073078481
Pharmacy in Bolivar, TN

Active since February 10, 2019CLIA 44D2316456 · Waiver
1355 W MARKET ST, BOLIVAR, TN 38008(731) 472-1011(423) 661-7602 Get Directions Write a Review

NPPES record last updated: August 2, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 2, 2019, Feb 10, 2019 (2 updates tracked since 2019).

About Southern Express Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN EXPRESS PHARMACY (NPI 1073078481) is a healthcare organization registered as a pharmacy in Bolivar, Tennessee and active in the NPI registry since February 2019. The organization holds a CLIA Waiver certificate valid through January 5, 2027 and lists Elizabeth Ashley Willis, Owner/pharmacist-in-charge, as its authorized official.

NPPES Registry Identity

NPI1073078481
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameSOUTHERN EXPRESS PHARMACY
Location Address1355 W MARKET STBolivar, TN 38008-1715
Mailing Address1355 W Market StBolivar, TN 38008-1715 · (731) 472-1011 · Fax (423) 661-7602
Phone(731) 472-1011
Fax(423) 661-7602
Organization SubpartNo
Authorized OfficialElizabeth Ashley WillisOwner/pharmacist-in-charge · (731) 472-1011
Enumeration DateFebruary 10, 2019
Last NPPES UpdateAugust 2, 20192 updates tracked since enumeration
✔ NPI 1073078481 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
Definition
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.
1355 W MARKET ST, Bolivar, TN 38008
Open in Google Maps ↗

Other Identifiers 2

Other00006619TN · Tn Board Of Pharmacy License Number
MedicaidQ048235TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2316456

Southern Express Pharmacy · Bolivar, TN
Active · expires Jan 5, 2027
CLIA Number44D2316456
Laboratory TypePharmacy
Certificate Effective DateJanuary 6, 2025
Certificate Expiration DateJanuary 5, 2027
Laboratory DirectorElizabeth A. Willis
Laboratory Phone(731) 472-1011
Laboratory LocationSouthern Express Pharmacy1355 W Market St, Bolivar, TN 38008
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
53 services52 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
48 services48 patients

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ELIZABETH ASHLEY WILLIS PHARMD
Pharmacist
1355 W MARKET ST
BOLIVAR, TN 38008
Hardeman County (731) 658-5271

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Express Pharmacy's NPI number?

The NPI number for Southern Express Pharmacy is 1073078481. It was assigned to this organization in the NPPES registry on February 10, 2019.

Where is Southern Express Pharmacy located?

Southern Express Pharmacy is located at 1355 W Market St, Bolivar, TN 38008. The listed phone number is (731) 472-1011.

What is Southern Express Pharmacy's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Southern Express Pharmacy hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2316456) is associated with this NPI, valid through January 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southern Express Pharmacy accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Southern Express Pharmacy as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southern Express Pharmacy was last updated on August 2, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.