Provider Demographics
NPI:1487759635
Name:PROPHARMAHP LLC
Entity type:Organization
Organization Name:PROPHARMAHP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRINER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-564-7002
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-0119
Mailing Address - Country:US
Mailing Address - Phone:912-564-7002
Mailing Address - Fax:912-564-0008
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:127 NORTH MAIN ST.
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1818
Practice Address - Country:US
Practice Address - Phone:912-564-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4435332B00000X
GAPHRE004495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00394504AMedicaid
GA1116979OtherNCPDP
GA1116979OtherNCPDP
GAFR7068504OtherDEA