MEDICARE: CHRISTIANS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	PHRE006261	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2012363	OTHER	PK

General Provider Information

NPI Number	:	1871586487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIANS PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30298-0158
Country	:	US
Telephone Number	:	404-366-4320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 MAIN ST
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1442
Country	:	US
Telephone Number	:	404-366-4320
Fax Number	:	404-366-0834

Authorized Official
Title or Position	:	OWNER PHCST
Name	:	JOHN CHAFIN
Credential	:	PHD
Telephone Number	:	404-366-4320

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/09/2015

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Directions to “CHRISTIANS PHARMACY INC ” Practice Location

Language	Start Address	Practice Location

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