Provider Demographics
NPI:1891068243
Name:HEISE, CRYSTAL D (PHARMD, BCOP)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:D
Last Name:HEISE
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:D
Other - Last Name:MAYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:STE 500B
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1787
Mailing Address - Fax:304-691-1477
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:304-598-4560
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH1000016931835P0018X
PARP4460571835P0018X
PARPI0058781835P0018X
MD222271835P0018X
VA02022124881835P0018X
WVRP00077601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist