Provider Demographics
NPI:1407981434
Name:RJ GRIFFIS ENTERPTISES LLC
Entity Type:Organization
Organization Name:RJ GRIFFIS ENTERPTISES LLC
Other - Org Name:BOSTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-498-6430
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31626-0068
Mailing Address - Country:US
Mailing Address - Phone:229-498-6430
Mailing Address - Fax:229-498-2997
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:GA
Practice Address - Zip Code:31626-2257
Practice Address - Country:US
Practice Address - Phone:229-498-6430
Practice Address - Fax:229-498-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008345333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1146578OtherNCPDP PROVIDER IDENTIFICATION NUMBER