Healthcare Provider Details

I. General information

NPI: 1316880677
Provider Name (Legal Business Name): CRESTLINE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WALL ST # 601
NEW YORK NY
10005-4301
US

IV. Provider business mailing address

18 MAPLE PL
CENTRAL ISLIP NY
11722-3203
US

V. Phone/Fax

Practice location:
  • Phone: 713-919-8141
  • Fax:
Mailing address:
  • Phone: 713-919-8141
  • Fax:

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: ALEXANDRIA PEREZ
Title or Position: MANAGER
Credential:
Phone: 713-919-8141