Provider Demographics
NPI:1679836142
Name:CRISP REGIONAL HOSPITAL, INC
Entity type:Organization
Organization Name:CRISP REGIONAL HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:HILL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:229-276-3386
Mailing Address - Street 1:902 N 7TH ST
Mailing Address - Street 2:902 N 7TH STREET
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3234
Mailing Address - Country:US
Mailing Address - Phone:229-276-3386
Mailing Address - Fax:229-276-3387
Practice Address - Street 1:216 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3275
Practice Address - Country:US
Practice Address - Phone:229-276-3372
Practice Address - Fax:229-276-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005310333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy