Healthcare Provider Details

I. General information

NPI: 1306753454
Provider Name (Legal Business Name): CRYSTAL CLEAR PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W HALLANDALE BEACH BLVD
HALLANDALE FL
33009-5160
US

IV. Provider business mailing address

3101 W HALLANDALE BEACH BLVD
HALLANDALE FL
33009-5160
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-6043
  • Fax: 305-230-2606
Mailing address:
  • Phone: 305-663-6043
  • Fax: 305-230-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA MARIE DAWKIN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 305-663-6043