Provider Demographics
NPI:1891151098
Name:NFORBINSON, CRYSTAL (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:
Last Name:NFORBINSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:NFORBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:17878 PRESTON RD APT 292
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4415 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3138
Practice Address - Country:US
Practice Address - Phone:903-792-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist