Provider Demographics
NPI:1598092967
Name:CHAMPION-KENDRICKS, CRYSTAL LATRICE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LATRICE
Last Name:CHAMPION-KENDRICKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11104 W AIRPORT BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3197
Mailing Address - Country:US
Mailing Address - Phone:713-777-6251
Mailing Address - Fax:903-923-0661
Practice Address - Street 1:11104 W AIRPORT BLVD STE 214
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3197
Practice Address - Country:US
Practice Address - Phone:713-777-6251
Practice Address - Fax:903-923-0661
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX041510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist