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General NPI Number Information
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NPI Number | 1902483712
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Entity Type | Organization
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Legal Business Name | SOUTHERN PHARMACARE LLC
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 755 S MAIN ST
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City | BAXLEY
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State | GA
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Zip | 31513-0130
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Country | US
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Telephone | 912-294-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 711 LAMBERT BENNETT RD
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City | JESUP
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State | GA
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Zip | 31546-1550
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Country | US
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Telephone | 912-705-7790
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Fax | 912-559-2597
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS RAY HARRISON
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Credential | PHARM D
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Telephone | 912-705-7790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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