Provider Demographics
NPI:1679619282
Name:GRIFFIN PHARMACY SERVICES INC
Entity type:Organization
Organization Name:GRIFFIN PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBURY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:770-233-8999
Mailing Address - Street 1:1012 MEMORIAL DR
Mailing Address - Street 2:STE 15
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-4411
Mailing Address - Country:US
Mailing Address - Phone:770-233-8999
Mailing Address - Fax:770-233-8976
Practice Address - Street 1:1012 MEMORIAL DR
Practice Address - Street 2:STE 15
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-4411
Practice Address - Country:US
Practice Address - Phone:770-233-8999
Practice Address - Fax:770-233-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0085773336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00935778AMedicaid
2014440OtherPK