Provider Demographics
NPI:1942318860
Name:PRN HEALTHCARE INC
Entity Type:Organization
Organization Name:PRN HEALTHCARE INC
Other - Org Name:PRN HEALTHCARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:G RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-942-6622
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068-0322
Mailing Address - Country:US
Mailing Address - Phone:478-472-2040
Mailing Address - Fax:478-472-9822
Practice Address - Street 1:298 MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068
Practice Address - Country:US
Practice Address - Phone:478-472-2040
Practice Address - Fax:478-472-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X, 3336C0004X, 3336S0011X
GAPHRE0074673336H0001X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145646OtherPK
=========OtherCHAMPUS TRICARE
GA87BBBBRMedicare ID - Type UnspecifiedLOCAL PART B
GA00716438BMedicaid
1123040001Medicare NSC