Provider Demographics
NPI:1790015345
Name:CRYSTAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CRYSTAL HEALTH SERVICES INC
Other - Org Name:NEWTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANOJNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-963-0444
Mailing Address - Street 1:9151 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4503
Mailing Address - Country:US
Mailing Address - Phone:410-363-8222
Mailing Address - Fax:410-363-2133
Practice Address - Street 1:9351 LAKESIDE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5063
Practice Address - Country:US
Practice Address - Phone:410-363-8222
Practice Address - Fax:410-363-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP051683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135019OtherNCPDP PROVIDER IDENTIFICATION NUMBER