Provider Demographics
NPI:1558610055
Name:DONJON, CRYSTAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DONJON
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 1:2495 WINDMILL WAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3536
Mailing Address - Country:US
Mailing Address - Phone:843-742-5789
Mailing Address - Fax:
Practice Address - Street 1:3411 SOCASTEE BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6111
Practice Address - Country:US
Practice Address - Phone:843-294-1285
Practice Address - Fax:843-294-1291
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist