Healthcare Provider Details

I. General information

NPI: 1750167441
Provider Name (Legal Business Name): KRYSTAL ELIZABETH COMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 SOUTH BLVD W
TROY MI
48098-6539
US

IV. Provider business mailing address

32633 WEXFORD DR
WARREN MI
48092-3297
US

V. Phone/Fax

Practice location:
  • Phone: 248-537-1011
  • Fax: 248-537-1013
Mailing address:
  • Phone: 586-944-1285
  • Fax: 248-537-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302415445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: