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Contact Information

SOUTHERN PHARMACARE LLC
73 SW PARK AVE
BAXLEY, GA31513
 Phone: 912-367-2488
 Fax: 912-367-7235
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SOUTHERN PHARMACARE LLC

NPI # 1710441621
LBN Legal business name SOUTHERN PHARMACARE LLC
Authorized official TRAVIS HARRISON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/24/2019
Last updated 10/07/2022 - About 4 years ago
Identifiers
GA Medicaid 000191441A
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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