Provider Demographics
NPI:1558897645
Name:WARD, CRYSTAL (RPH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1580 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2934
Mailing Address - Country:US
Mailing Address - Phone:970-564-1353
Mailing Address - Fax:
Practice Address - Street 1:1580 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2934
Practice Address - Country:US
Practice Address - Phone:970-564-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11129183500000X
CO16196183500000X
UT9867503-1701183500000X
UT9867503-8911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
277115OtherNABP