Provider Demographics
NPI:1275803306
Name:JOSEPH, CRYSTAL (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:DANELLE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MBA
Mailing Address - Street 1:1045 LEVI BEAMS RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:KY
Mailing Address - Zip Code:42757-7997
Mailing Address - Country:US
Mailing Address - Phone:270-774-7767
Mailing Address - Fax:
Practice Address - Street 1:1045 LEVI BEAMS RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:KY
Practice Address - Zip Code:42757-7997
Practice Address - Country:US
Practice Address - Phone:270-774-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015805183500000X
MI5302040608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist