# SOUTHERN PHARMACY GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154922441
- **Authorized official:** TRAVIS RAY HARRISON PHARMD (OWNER)
- **Authorized official phone:** (912) 294-1684

## Contact information

- **Practice address:** 110 ALLISON ST., JESUP, GA 31545
- **Practice address phone:** (912) 559-2961
- **Practice address fax:** (912) 559-2597
- **Mailing address:** 711 LAMBERT BENNETT RD, JESUP, GA 31546
- **Mailing address phone:** (912) 294-1684
- **Mailing address fax:** (912) 559-2597

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/04/2020
- **Last updated:** 11/04/2020