Organization Active NPI

Dennard Inc

Doing business as Dennards LTC

  • Long Term Care Pharmacy
  • Soperton, GA
National Provider Identifier
1164730669
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHRE009683 Issued in GA
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, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
003100424AMedicaidGA
2126572OtherPK

Other names 1

  • Dennards LTC Doing business as

National Provider Directory

National Provider Directory

Locations

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.

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.

Verify at the official NPI Registry.