Provider Demographics
NPI:1982769311
Name:CHRISTIANS PHARMACY & HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CHRISTIANS PHARMACY & HEALTH SERVICES INC
Other - Org Name:CHRISTIANS HEALTH SERVICES
Other - Org Type:Doing Business As
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:PHARMD
Authorized Official - Phone:404-362-6901
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:2006-12-26
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336H0001X, 3336S0011X
GAPHHH0000123336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1151997OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA009096730AMedicaid
GA009096730AMedicaid