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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11482
MS
3336L0003X
Long Term Care Pharmacy
—
—
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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