Provider Demographics
NPI:1205134947
Name:CRISPEN, ELIZABETH KAY (RPH)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KAY
Last Name:CRISPEN
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 1:103 PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2579
Mailing Address - Country:US
Mailing Address - Phone:757-868-5553
Mailing Address - Fax:
Practice Address - Street 1:421 WYTHE CREEK RD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1915
Practice Address - Country:US
Practice Address - Phone:757-868-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022045134513183500000X
IN26017007A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist