Provider Demographics
NPI:1811322118
Name:MOORE, CRYSTAL LYNN
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LYNN
Last Name:MOORE
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 1:11400 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5310
Mailing Address - Country:US
Mailing Address - Phone:727-848-3445
Mailing Address - Fax:727-848-3656
Practice Address - Street 1:11400 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5310
Practice Address - Country:US
Practice Address - Phone:727-848-3445
Practice Address - Fax:727-848-3656
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist