Provider Demographics
NPI:1649314931
Name:CARTY, CRYSTAL DAWN (RPH)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:CARTY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DAWN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:900 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1717
Mailing Address - Country:US
Mailing Address - Phone:815-562-2181
Mailing Address - Fax:815-561-2772
Practice Address - Street 1:900 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1717
Practice Address - Country:US
Practice Address - Phone:815-562-2181
Practice Address - Fax:815-561-2772
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13948183500000X
IL051-287218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist