Provider Demographics
NPI:1013546357
Name:CHOI, CRYSTAL DIANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:DIANE
Last Name:CHOI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:DIANE
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:349 SPRINGFIELD ST APT 20
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5261
Mailing Address - Country:US
Mailing Address - Phone:352-208-0930
Mailing Address - Fax:
Practice Address - Street 1:349 SPRINGFIELD ST APT 20
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5261
Practice Address - Country:US
Practice Address - Phone:352-208-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist