Provider Demographics
NPI:1518117399
Name:SPAID, CRYSTAL M (RPH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:SPAID
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 1:20 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1322
Mailing Address - Country:US
Mailing Address - Phone:301-334-2197
Mailing Address - Fax:
Practice Address - Street 1:20 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1322
Practice Address - Country:US
Practice Address - Phone:301-334-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18912183500000X
WVRP0006844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1356398903OtherBUSINESS NPI NUMBER
MD407077100Medicaid
MD407077100Medicaid