Healthcare Provider Details

I. General information

NPI: 1871586487
Provider Name (Legal Business Name): CHRISTIANS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 MAIN ST
FOREST PARK GA
30297-1442
US

IV. Provider business mailing address

PO BOX 158
FOREST PARK GA
30298-0158
US

V. Phone/Fax

Practice location:
  • Phone: 404-366-4320
  • Fax: 404-366-0834
Mailing address:
  • Phone: 404-366-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006261
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0024758B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier0024758C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 3
Identifier0024758A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier2012363
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: JOHN CHAFIN
Title or Position: OWNER PHCST
Credential: PHD
Phone: 404-366-4320