Provider Demographics
NPI:1962837179
Name:WEST, KRYSTA (RPH)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:WEST
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 1:1112 AKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AL
Mailing Address - Zip Code:35905-7285
Mailing Address - Country:US
Mailing Address - Phone:256-613-3224
Mailing Address - Fax:
Practice Address - Street 1:107 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1044
Practice Address - Country:US
Practice Address - Phone:256-613-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13284183500000X
GA024112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist