# DEER CREEK PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Deep Delta Drugs
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174871057
- **Authorized official:** CHARLIE DARDEN (OWNER)
- **Authorized official phone:** (662) 873-7135

## Contact information

- **Practice address:** 56 S FOURTH ST, ROLLING FORK, MS 39159-5147
- **Practice address phone:** (662) 873-6006
- **Mailing address:** 56 S FOURTH ST, ROLLING FORK, MS 39159-5147
- **Mailing address phone:** (662) 873-6006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 11482 | MS | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/27/2012
- **Last updated:** 05/09/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2136470 | PK | — |