Provider Demographics
NPI:1396461943
Name:DAO, KRYSTLE YEN
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:YEN
Last Name:DAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E DORIS ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2785
Mailing Address - Country:US
Mailing Address - Phone:602-865-9788
Mailing Address - Fax:
Practice Address - Street 1:11425 W BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6810
Practice Address - Country:US
Practice Address - Phone:602-865-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist