Provider Demographics
NPI:1518681436
Name:HATTUM, CRYSTAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:HATTUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1325 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1007
Mailing Address - Country:US
Mailing Address - Phone:605-322-3893
Mailing Address - Fax:
Practice Address - Street 1:1000 E 23RD ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2108
Practice Address - Country:US
Practice Address - Phone:605-322-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD64961835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology