Provider Demographics
NPI:1457871931
Name:NA, CRYSTAL
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:NA
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 1:3106 FARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1906
Mailing Address - Country:US
Mailing Address - Phone:718-886-6262
Mailing Address - Fax:844-309-8132
Practice Address - Street 1:3106 FARRINGTON ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1906
Practice Address - Country:US
Practice Address - Phone:718-886-6262
Practice Address - Fax:844-309-8132
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist