Provider Demographics
NPI:1679829881
Name:BURROUGHS, CRYSTEL S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTEL
Middle Name:S
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 MARTIN LOOP
Mailing Address - Street 2:BLDG 9200
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5648
Mailing Address - Country:US
Mailing Address - Phone:706-544-1049
Mailing Address - Fax:706-544-1081
Practice Address - Street 1:7950 MARTIN LOOP
Practice Address - Street 2:BLDG 9200
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5648
Practice Address - Country:US
Practice Address - Phone:706-544-1049
Practice Address - Fax:706-544-1081
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist