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NPI Code Detail

MEDICARE: MRS. CRYSTAL JEAN BRYNER RPH, MBA, CDE

MEDICARE: MRS. CRYSTAL JEAN BRYNER RPH, MBA, CDE
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
1183500000XPharmacistS11174AZ

General Provider Information

NPI Number : 1477554053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRYSTAL JEAN BRYNER RPH, MBA, CDE
Provider Business Mailing Address
First Line : 3889 E DOUGLAS LOOP
Second Line :
City : GILBERT
State : AZ
Zip : 85234-3056
Country : US
Telephone Number : 480-861-7858
Fax Number : 623-334-3257
Provider Business Practice Location Address
First Line : 9043 W OLIVE AVE
Second Line :
City : PEORIA
State : AZ
Zip : 85345-7049
Country : US
Telephone Number : 623-334-3087
Fax Number : 623-334-3257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/08/2007

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