Provider Demographics
NPI:1811037138
Name:HALLORAN, CHRYSTAL MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRYSTAL
Middle Name:MICHELLE
Last Name:HALLORAN
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 1:108 GLENEAGLES BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8495
Mailing Address - Country:US
Mailing Address - Phone:859-626-3476
Mailing Address - Fax:
Practice Address - Street 1:651 PERIMETER DR STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4136
Practice Address - Country:US
Practice Address - Phone:800-787-2680
Practice Address - Fax:859-335-3700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist