Little Creek Drug LLC
Organization Active NPI Community/Retail Pharmacy · MC Rae- Helena, GA
NPI 1831559152 · NPPES record last updated Nov 25, 2020
Key facts
- NPI
- 1831559152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- LITTLE CREEK DRUG LLC
- Practice address
- 141 Eighth St.
MC Rae- Helena, GA 31037 - Phone
- (229) 868-2580
- Fax
- (229) 868-2529
- NPI assigned
- Feb 29, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Travis Ray Harrison, PHARM D
- Title
- Owner
- Phone
- (912) 294-1684
Corporate family (same tax ID) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210902001178 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6406252212 | Practice locations: MC Rae Helena, GA |
National Provider Directory
- Tax ID family
- Fred'S Pharmacy 3816
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
141 Eighth St.
MC Rae- Helena, GA 31037
Mailing address
711 Lambert Bennett Rd
Jesup, GA 31546
Phone (229) 868-2580
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003174007A | Medicaid | GA |
Other names
- Fred's Pharmacy #3816
- Smith's Pharmacy
Other providers in MC Rae- Helena, GA
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- Hollie Padgett Harrelson
- Hospital Authority of Jeff Davis County Georgia
- Marli Howell
- Elizabeth Marie Kiene
- Andrew Travis Luke
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- Erica Thomas
- Vanessa Thompson
- Valarie Irene Webb
All providers in MC Rae- Helena, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.