Provider Demographics
NPI:1821164922
Name:CHRISTIANS PHARMACY MCDONOUGH
Entity Type:Organization
Organization Name:CHRISTIANS PHARMACY MCDONOUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-362-2990
Mailing Address - Street 1:4313 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4313 JODECO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8297
Practice Address - Country:US
Practice Address - Phone:770-320-8121
Practice Address - Fax:770-320-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHHH000016333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1152507OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5297210001Medicare ID - Type Unspecified