Provider Demographics
NPI:1346865029
Name:PERKINS, CRYSTAL LEANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEANN
Last Name:PERKINS
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 1:193 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-6307
Mailing Address - Country:US
Mailing Address - Phone:276-880-5112
Mailing Address - Fax:
Practice Address - Street 1:116 FLANAGAN AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4514
Practice Address - Country:US
Practice Address - Phone:276-889-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist