Provider Demographics
NPI:1255780441
Name:CRISP & ASSOCIATES II, LLC
Entity type:Organization
Organization Name:CRISP & ASSOCIATES II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-362-2990
Mailing Address - Street 1:4980 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1472
Mailing Address - Country:US
Mailing Address - Phone:404-362-2990
Mailing Address - Fax:404-362-2994
Practice Address - Street 1:4980 PHILLIPS DR
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1472
Practice Address - Country:US
Practice Address - Phone:404-362-2990
Practice Address - Fax:404-362-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHHH000063333600000X, 3336H0001X, 3336S0011X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy