Provider Demographics
NPI:1467772137
Name:CRIST, DEBORAH SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:CRIST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ANN ARBOR RD W
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2127
Mailing Address - Country:US
Mailing Address - Phone:734-737-0218
Mailing Address - Fax:734-737-0506
Practice Address - Street 1:800 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2127
Practice Address - Country:US
Practice Address - Phone:734-737-0218
Practice Address - Fax:734-737-0506
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist