Provider Demographics
NPI:1831495035
Name:BROWN, CRYSTAL D (PHARMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 CARLSBAD DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0690
Mailing Address - Country:US
Mailing Address - Phone:806-787-6733
Mailing Address - Fax:
Practice Address - Street 1:221 W COLORADO BLVD STE 933
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2362
Practice Address - Country:US
Practice Address - Phone:806-787-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist