Provider Demographics
NPI:1336394923
Name:CHA, CRYSTAL NMN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:NMN
Last Name:CHA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N MERGANSER DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-8117
Mailing Address - Country:US
Mailing Address - Phone:828-448-4195
Mailing Address - Fax:
Practice Address - Street 1:3451 JOHN WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:CONNELLYS SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-7338
Practice Address - Country:US
Practice Address - Phone:828-448-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2017-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3902000000X390200000X
NC22066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program