Provider Demographics
NPI:1518936442
Name:GARDI DRUG COMPANY, LLC
Entity Type:Organization
Organization Name:GARDI DRUG COMPANY, LLC
Other - Org Name:BARBER'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-294-1684
Mailing Address - Street 1:731 CAMERON DR.
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516
Mailing Address - Country:US
Mailing Address - Phone:912-449-4444
Mailing Address - Fax:912-449-8735
Practice Address - Street 1:731 CAMERON DR.
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516
Practice Address - Country:US
Practice Address - Phone:912-449-4444
Practice Address - Fax:912-449-8735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
GAPHR 004024333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH009806OtherPHARMACIST LICENSE
GA1121653OtherNCPDP / NABP
GAPHR004024OtherPHARMACY STATE LICENSE
GA000038398AMedicaid
GA00003898AMedicaid
GA00003898AMedicaid
GA000038398AMedicaid
GA1121653OtherNCPDP / NABP