Provider Demographics
NPI:1063861730
Name:CRISP & ASSOCIATES I, LLC
Entity Type:Organization
Organization Name:CRISP & ASSOCIATES I, LLC
Other - Org Name:CHRISTIANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-362-2990
Mailing Address - Street 1:1032 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1442
Mailing Address - Country:US
Mailing Address - Phone:404-366-4320
Mailing Address - Fax:404-366-0834
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:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE010290333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy