Provider Demographics
NPI:1871586487
Name:CHRISTIANS PHARMACY INC
Entity type:Organization
Organization Name:CHRISTIANS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-366-4320
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30298-0158
Mailing Address - Country:US
Mailing Address - Phone:404-366-4320
Mailing Address - Fax:
Practice Address - Street 1:1032 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1442
Practice Address - Country:US
Practice Address - Phone:404-366-4320
Practice Address - Fax:404-366-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
GAPHRE0062613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0024758BMedicaid
GA0024758CMedicaid
GA0024758AMedicaid
2012363OtherPK
0431240001Medicare NSC