Organization
SGBS HOLDINGS LLC
Active
Other names
Southern Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY GIRARDEAU (CO-OWNER)
(912) 839-5456
Entity
Organization
Contact information
Practice address
606 BRANNEN ST STE B, STATESBORO, GA 30458-5184
(912) 225-9279
Mailing address
606 BRANNEN ST STE B, STATESBORO, GA 30458-5184
(912) 225-9279
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009817
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1162116
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/16/2012
Last updated
03/27/2012
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