Provider Demographics
NPI:1407522337
Name:TOLOZA, CRYSTAL PATRICIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:PATRICIA
Last Name:TOLOZA
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 1:3736 SW 11TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7921
Mailing Address - Country:US
Mailing Address - Phone:786-417-0167
Mailing Address - Fax:
Practice Address - Street 1:2160 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3417
Practice Address - Country:US
Practice Address - Phone:239-332-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist