Provider Demographics
NPI:1821441502
Name:HUNTRODS, CRYSTAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HUNTRODS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:HOSTETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 S DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5420
Mailing Address - Country:US
Mailing Address - Phone:307-686-5166
Mailing Address - Fax:
Practice Address - Street 1:2300 S DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5420
Practice Address - Country:US
Practice Address - Phone:307-686-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5923183500000X
WY3466183500000X
NE13855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist