Provider Demographics
NPI:1336545516
Name:CRISPIN, HEATHER (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CRISPIN
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 1:209 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1206
Mailing Address - Country:US
Mailing Address - Phone:785-364-4619
Mailing Address - Fax:785-364-2183
Practice Address - Street 1:209 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1206
Practice Address - Country:US
Practice Address - Phone:785-364-4619
Practice Address - Fax:785-364-2183
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist