Silver Creek RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE010266 Issued in GA

Legal business name

SILVER CREEK RX LLC

Practice address

4450 Rockmart Rd SE
Silver Creek, GA 30173-2438

Phone

(706) 292-0106

Fax

(706) 292-0647

NPI assigned

Jan 22, 2007

Organization subpart

No

Name

Lisa Cornett Harris, RPHNPI 1588948558

Title

Owner

Phone

(706) 292-0106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Cornett Harris, RPH

  • Pharmacist
  • Rome, GA
  • NPI 1588948558
  NPD Authorized official
• Elbert William Fricks, PHARMACIST

  • Pharmacist
  • Silver Creek, GA
  • NPI 1194853366
  NPD (past)
• Ann Childers Moss

  • Pharmacist
  • Silver Creek, GA
  • NPI 1164024840
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

• SILVER CREEK PHARMACY Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 30, 2025.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1780738245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "SILVER CREEK",
            "state": "GA",
            "postal_code": "301732438",
            "telephone_number": "706-292-0106",
            "fax_number": "706-292-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 ROCKMART RD SE",
            "city": "SILVER CREEK",
            "state": "GA",
            "postal_code": "301732438",
            "telephone_number": "706-292-0106",
            "fax_number": "706-292-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER CREEK RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "CORNETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-292-0106",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010266",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000821818A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158643",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SILVER CREEK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ann Childers Moss
• Reynolds Mobile Phlebotomy
• Laci Reynolds
• Devyn Haas Shiflett, FNP-C
• Lynn King Shirley, LPC

• All providers in Silver Creek, GA
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.