Provider Demographics
NPI:1205857273
Name:CHRISTIAN FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:CHRISTIAN FAMILY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR.
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-343-0734
Mailing Address - Street 1:79 HIGHWAY 51 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-4580
Mailing Address - Country:US
Mailing Address - Phone:731-635-1569
Mailing Address - Fax:731-635-7920
Practice Address - Street 1:79 HIGHWAY 51 S
Practice Address - Street 2:SUITE 2
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-4580
Practice Address - Country:US
Practice Address - Phone:731-635-1569
Practice Address - Fax:731-635-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TN00000042483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094985OtherPK
TN1205857273Medicaid
2094985OtherPK