Provider Demographics
NPI:1356757306
Name:MCDUFFIE, CRYSTAL (PHARMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 SEDGEWICK DR
Mailing Address - Street 2:#104
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8115
Mailing Address - Country:US
Mailing Address - Phone:228-343-5241
Mailing Address - Fax:
Practice Address - Street 1:1691 J A COCHRAN BYP
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-2204
Practice Address - Country:US
Practice Address - Phone:803-581-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35388183500000X
NC23758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist