Provider Demographics
NPI:1275151193
Name:KRUSTCHINSKY, LORI JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:KRUSTCHINSKY
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 1:1220 HOBBS REACH LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6464
Mailing Address - Country:US
Mailing Address - Phone:979-574-6805
Mailing Address - Fax:
Practice Address - Street 1:1220 HOBBS REACH LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-6464
Practice Address - Country:US
Practice Address - Phone:979-574-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501111835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty