Provider Demographics
NPI:1477554053
Name:BRYNER, CRYSTAL JEAN (RPH, MBA, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JEAN
Last Name:BRYNER
Suffix:
Gender:F
Credentials:RPH, MBA, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 E DOUGLAS LOOP
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3056
Mailing Address - Country:US
Mailing Address - Phone:480-861-7858
Mailing Address - Fax:623-334-3257
Practice Address - Street 1:9043 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7049
Practice Address - Country:US
Practice Address - Phone:623-334-3087
Practice Address - Fax:623-334-3257
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS11174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist