Provider Demographics
NPI:1457018251
Name:DO, KRYSTAL TRAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:TRAM
Last Name:DO
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 1:3032 KREGEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-6324
Mailing Address - Country:US
Mailing Address - Phone:815-980-1995
Mailing Address - Fax:
Practice Address - Street 1:230 W CHRYSLER DR
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-6304
Practice Address - Country:US
Practice Address - Phone:815-544-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist