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Organization
DEER CREEK PHARMACY LLC
Active
Organization
DEER CREEK PHARMACY LLC
Active
Other names
Deep Delta Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLIE DARDEN (OWNER)
(662) 873-7135
Entity
Organization
Contact information
Practice address
56 S FOURTH ST, ROLLING FORK, MS 39159-5147
(662) 873-6006
Mailing address
56 S FOURTH ST, ROLLING FORK, MS 39159-5147
(662) 873-6006
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
11482
MS
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136470
PK
—
Enumeration date
08/27/2012
Last updated
05/09/2016
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