Provider Demographics
NPI:1609949924
Name:BLUE RIDGE PHARMACY
Entity Type:Organization
Organization Name:BLUE RIDGE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HONEYCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-632-2244
Mailing Address - Street 1:793 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4576
Mailing Address - Country:US
Mailing Address - Phone:706-632-2244
Mailing Address - Fax:706-642-4440
Practice Address - Street 1:793 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4576
Practice Address - Country:US
Practice Address - Phone:706-632-2244
Practice Address - Fax:706-642-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005892333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy