MEDICARE: CRYSTAL REEVES PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH031597	GA

General Provider Information

NPI Number	:	1063068971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL REEVES PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 139
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31059-0139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5675 JONESBORO RD
Second Line	:
City	:	LAKE CITY
State	:	GA
Zip	:	30260-3804
Country	:	US
Telephone Number	:	678-422-1808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	12/18/2022

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