Provider Demographics
NPI:1790870251
Name:PARRIS PHARMACY, INC
Entity Type:Organization
Organization Name:PARRIS PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-632-2294
Mailing Address - Street 1:PO BOX 2230
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-0039
Mailing Address - Country:US
Mailing Address - Phone:706-632-2294
Mailing Address - Fax:706-632-3568
Practice Address - Street 1:4295 OLD HIGHWAY 76
Practice Address - Street 2:SUITE H
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-8002
Practice Address - Country:US
Practice Address - Phone:706-632-2294
Practice Address - Fax:706-632-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1106790OtherNCPDP
GA00029598AMedicaid
BP9384190OtherDEA LICENSE