Healthcare Provider Details

I. General information

NPI: 1093024226
Provider Name (Legal Business Name): CRYSTAL C HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 BATTLEFIELD BLVD S
CHESAPEAKE VA
23322-5312
US

IV. Provider business mailing address

614 INDIAN CEDAR DR
CHESAPEAKE VA
23320-3573
US

V. Phone/Fax

Practice location:
  • Phone: 757-482-3391
  • Fax:
Mailing address:
  • Phone: 757-436-9837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202012364
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: