Provider Demographics
NPI:1609174465
Name:GARCIA, CRYSTAL B (RPH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:B
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 REIDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3652
Mailing Address - Country:US
Mailing Address - Phone:864-587-9486
Mailing Address - Fax:864-587-9504
Practice Address - Street 1:2410 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3652
Practice Address - Country:US
Practice Address - Phone:864-587-9486
Practice Address - Fax:864-587-9504
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH11528183500000X
GARPH017570183500000X
WAPH00042981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist