MEDICARE: SOUTHERN SHORES PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1518823640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SHORES PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2658 US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3374
Country	:	US
Telephone Number	:	912-356-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2658 US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3374
Country	:	US
Telephone Number	:	912-356-9900
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	KELLY LOWERTS DICK
Credential	:	PHARM. D.
Telephone Number	:	912-356-9900

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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