Provider Demographics
NPI:1851685127
Name:GENZIANO, CRYSTAL M (RPH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:GENZIANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15700 E BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1558
Mailing Address - Country:US
Mailing Address - Phone:720-214-6001
Mailing Address - Fax:
Practice Address - Street 1:15700 E BRIARWOOD CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1558
Practice Address - Country:US
Practice Address - Phone:720-214-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist