Provider Demographics
NPI:1891358958
Name:MCCARTY, CRYSTLE MICHELLE
Entity Type:Individual
Prefix:
First Name:CRYSTLE
Middle Name:MICHELLE
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 2ND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4430
Mailing Address - Country:US
Mailing Address - Phone:308-234-8056
Mailing Address - Fax:308-234-8060
Practice Address - Street 1:2706 2ND AVE STE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4430
Practice Address - Country:US
Practice Address - Phone:308-234-8056
Practice Address - Fax:308-234-8060
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist