Healthcare Provider Details

I. General information

NPI: 1922990738
Provider Name (Legal Business Name): MILES LYNN CRISMON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 MURMURING CREEK DR
AUSTIN TX
78736-2923
US

IV. Provider business mailing address

9600 MURMURING CREEK DR
AUSTIN TX
78736-2923
US

V. Phone/Fax

Practice location:
  • Phone: 512-663-5068
  • Fax:
Mailing address:
  • Phone: 512-663-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number22035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: