Provider Demographics
NPI:1336749019
Name:NGUYEN, CRYSTAL ANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANA
Last Name:NGUYEN
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 1:4375 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2525
Mailing Address - Country:US
Mailing Address - Phone:706-355-3090
Mailing Address - Fax:706-355-3099
Practice Address - Street 1:4375 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2525
Practice Address - Country:US
Practice Address - Phone:706-355-3090
Practice Address - Fax:706-355-3099
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62943183500000X
GARPH028578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist