Provider Demographics
NPI:1942725882
Name:ADAMS, CRYSTAL E (RPH)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:E
Last Name:ADAMS
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 1:1375 SYCAMORE AVE APT 272
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5538
Mailing Address - Country:US
Mailing Address - Phone:205-540-0659
Mailing Address - Fax:
Practice Address - Street 1:909 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3505
Practice Address - Country:US
Practice Address - Phone:415-258-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist