Healthcare Provider Details

I. General information

NPI: 1306857115
Provider Name (Legal Business Name): KRYSTAL LIEBZEIT EDWARDS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD BLDG 7, R#119A
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD BLDG 7, R#119A
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-372-5300
  • Fax: 214-372-5020
Mailing address:
  • Phone: 214-372-5300
  • Fax: 214-372-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number41128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: