Provider Demographics
NPI:1467723916
Name:WALKER, CRYSTAL JAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JAYNE
Last Name:WALKER
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 1:7516 RED MILL CIR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2322
Mailing Address - Country:US
Mailing Address - Phone:407-222-3391
Mailing Address - Fax:
Practice Address - Street 1:6302 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2530
Practice Address - Country:US
Practice Address - Phone:727-815-3233
Practice Address - Fax:727-815-3233
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist