Healthcare Provider Details

I. General information

NPI: 1922326073
Provider Name (Legal Business Name): CRYSTAL LEE ENDSLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

PO BOX 1872
YUMA AZ
85366-2385
US

V. Phone/Fax

Practice location:
  • Phone: 210-896-7744
  • Fax:
Mailing address:
  • Phone: 602-412-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS017547
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: