Provider Demographics
NPI:1295964146
Name:RICCIO, KRYSTAL KC (PHARMD, BCACP, CDCES)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:KC
Last Name:RICCIO
Suffix:
Gender:F
Credentials:PHARMD, BCACP, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2333
Mailing Address - Country:US
Mailing Address - Phone:702-968-5582
Mailing Address - Fax:
Practice Address - Street 1:3050 E DESERT INN RD STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3872
Practice Address - Country:US
Practice Address - Phone:702-796-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV176251835P2201X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care