Healthcare Provider Details

I. General information

NPI: 1952225708
Provider Name (Legal Business Name): KRYSTAL ETSUKO ASARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 N NEVADA AVE
COLORADO SPRINGS CO
80918-8602
US

IV. Provider business mailing address

5050 N NEVADA AVE
COLORADO SPRINGS CO
80918-8602
US

V. Phone/Fax

Practice location:
  • Phone: 719-264-5019
  • Fax:
Mailing address:
  • Phone: 719-264-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0025647
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: