Provider Demographics
NPI:1720391253
Name:WOOD, CHRYSTAL S (RPH, PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ROSEDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-534-0053
Mailing Address - Fax:575-534-9684
Practice Address - Street 1:100 N ROSEDALE ROAD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-534-0053
Practice Address - Fax:575-534-9684
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist