Provider Demographics
NPI:1790427847
Name:WELLS, CRYSTAL JEANETTE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JEANETTE
Last Name:WELLS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 GEORGE WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2626
Mailing Address - Country:US
Mailing Address - Phone:509-943-2605
Mailing Address - Fax:
Practice Address - Street 1:1601 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2626
Practice Address - Country:US
Practice Address - Phone:509-943-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60672953183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician