Organization
SOUTHERN PHARMACARE LLC
Active
Other names
Fulghum Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS RAY HARRISON PHARM D (OWNER)
(912) 294-1684
Entity
Organization
Contact information
Practice address
73 SW PARK AVE, BAXLEY, GA 31513
(912) 367-2488
(912) 367-7235
Mailing address
711 LAMBERT BENNETT RD, JESUP, GA 31546
(912) 294-1684
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000191441A
—
GA
Enumeration date
01/24/2019
Last updated
10/07/2022
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