Healthcare Provider Details

I. General information

NPI: 1487759635
Provider Name (Legal Business Name): PROPHARMAHP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N MAIN ST 127 NORTH MAIN ST.
SYLVANIA GA
30467-1818
US

IV. Provider business mailing address

PO BOX 119
SYLVANIA GA
30467-0119
US

V. Phone/Fax

Practice location:
  • Phone: 912-564-7002
  • Fax:
Mailing address:
  • Phone: 912-564-7002
  • Fax: 912-564-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE004495
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4435
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTOPHER LEE GRINER
Title or Position: OWNER/ MANAGER
Credential: PHARMD
Phone: 912-564-7002