Healthcare Provider Details

I. General information

NPI: 1558339838
Provider Name (Legal Business Name): SOPERTON PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MAIN ST W
SOPERTON GA
30457-1169
US

IV. Provider business mailing address

112 MAIN ST W
SOPERTON GA
30457-1169
US

V. Phone/Fax

Practice location:
  • Phone: 912-529-3234
  • Fax: 912-529-6197
Mailing address:
  • Phone: 912-529-3234
  • Fax: 912-529-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHERE003318
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE003318
License Number StateGA

VIII. Authorized Official

Name: E WESLEY CROWE
Title or Position: PRESIDENT
Credential: RPH
Phone: 912-529-3234