Organization
LITTLE CREEK DRUG LLC
Active
Other names
Southern Drug Co- Darien
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS RAY HARRISON PHARM D (OWNER)
(912) 294-1684
Entity
Organization
Contact information
Practice address
1001 NORTH WAY, DARIEN, GA 31305
(912) 437-6353
(912) 437-7621
Mailing address
711 LAMBERT BENNETT RD, JESUP, GA 31546
(912) 294-1684
(912) 437-7621
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
8398
GA
3336C0003X
Community/Retail Pharmacy
8398
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00862672A
—
GA
01
—
1147049
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/26/2006
Last updated
08/24/2020
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