Active NPI
Dennard Inc
Doing business as Dennards LTC
- Long Term Care Pharmacy
- Soperton, GA
National Provider Identifier
1164730669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- PHRE009683
- Legal business name
- DENNARD INC
- Doing business as
- Dennards LTC
- Practice address
- 804 Second St
Soperton, GA 30457-2402 - Phone
- (912) 529-2021
- Fax
- (912) 529-2031
- NPI assigned
- Sep 17, 2010
- Last updated
- Sep 19, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Blake Dennard
- Title
- VP/Owner
- Phone
- (912) 529-2021
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Long Term Care Pharmacy | 3336L0003X | PHRE009683 | GA | Primary |
Addresses
Primary practice location
804 Second St
Soperton, GA 30457-2402
Mailing address
804 Second St
Soperton, GA 30457-2402
Phone (912) 529-2021
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003100424A | Medicaid | GA | |
| 2126572 | Other | PK |
Other names 1
- Dennards LTC
National Provider Directory
National Provider DirectoryLocations
804 Second St
Soperton, GA 30457
Phone (912) 529-2021
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Soperton, GA
- NPI 1932676152
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284681600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1758240000000",
"number": "1164730669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 SECOND ST",
"city": "SOPERTON",
"state": "GA",
"postal_code": "304572402",
"telephone_number": "912-529-2021",
"fax_number": "912-529-2031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 SECOND ST",
"city": "SOPERTON",
"state": "GA",
"postal_code": "304572402",
"telephone_number": "912-529-2021",
"fax_number": "912-529-2031"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DENNARD INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-17",
"last_updated": "2025-09-19",
"certification_date": "2022-09-02",
"status": "A",
"authorized_official_last_name": "DENNARD",
"authorized_official_first_name": "BLAKE",
"authorized_official_title_or_position": "VP/OWNER",
"authorized_official_telephone_number": "912-529-2021"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "GA",
"license": "PHRE009683",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003100424A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2126572",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Dennards LTC",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Soperton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.