# OLDE TIME PHARMACY AT SIXES LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Olde Time Pharmacy at Sixes, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912208539
- **Authorized official:** SHAD SUTHERLAND (OWNER)
- **Authorized official phone:** (770) 783-0483

## Contact information

- **Practice address:** 684 SIXES RD STE 105, HOLLY SPRINGS, GA 30115-8720
- **Practice address phone:** (770) 783-0483
- **Mailing address:** 684 SIXES RD, SUITE 105, HOLLY SPRINGS, GA 30115-8721
- **Mailing address phone:** (770) 783-0483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009711 | GA | Yes |

## Other

- **Enumeration date:** 11/12/2010
- **Last updated:** 12/01/2010