Provider Demographics
NPI:1073097739
Name:BECHTEL, CHRYSTALYNNE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRYSTALYNNE
Middle Name:MARIE
Last Name:BECHTEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-7657
Mailing Address - Country:US
Mailing Address - Phone:601-297-8143
Mailing Address - Fax:
Practice Address - Street 1:1260 FRONT ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2054
Practice Address - Country:US
Practice Address - Phone:985-641-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist