Provider Demographics
NPI:1083050777
Name:FRANCKSEN, CRYSTAL M (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:FRANCKSEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 RACHEL PL
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2309
Mailing Address - Country:US
Mailing Address - Phone:608-322-6864
Mailing Address - Fax:
Practice Address - Street 1:2626 ROSE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-1616
Practice Address - Country:US
Practice Address - Phone:608-781-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16594183500000X
CA65215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist