Provider Demographics
NPI:1932797313
Name:MEMMER, KRYSTAL MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:MARIE
Last Name:MEMMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KRYSTAL
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2037 MAGINOAK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1884
Mailing Address - Country:US
Mailing Address - Phone:516-993-4815
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-281-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist