Provider Demographics
NPI:1073800199
Name:CHAU, CRYSTAL (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:
Last Name:CHAU
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 1:3030 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2562
Mailing Address - Country:US
Mailing Address - Phone:714-979-6743
Mailing Address - Fax:714-361-2574
Practice Address - Street 1:3030 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2562
Practice Address - Country:US
Practice Address - Phone:714-979-6743
Practice Address - Fax:714-361-2574
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist