Provider Demographics
NPI:1578166575
Name:LEE-TANIHU, KRYSTAL AVERY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:AVERY
Last Name:LEE-TANIHU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KRYSTAL
Other - Middle Name:AVERY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1225 N BLUEGROVE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2317 CROW CREEK CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4104
Practice Address - Country:US
Practice Address - Phone:770-364-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist