Provider Demographics
NPI:1629400742
Name:KIRKENDOL, CRYSTAL GAIL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:GAIL
Last Name:KIRKENDOL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:GAIL
Other - Last Name:MOIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1044 NUNNERY LANE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221
Mailing Address - Country:US
Mailing Address - Phone:203-376-1337
Mailing Address - Fax:
Practice Address - Street 1:1044 NUNNERY LANE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-6626
Practice Address - Country:US
Practice Address - Phone:203-376-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist