Healthcare Provider Details

I. General information

NPI: 1639953029
Provider Name (Legal Business Name): CRYSTAL B ALDERMAN CPHT ADV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 DANVILLE PIKE
LAUREL FORK VA
24352-3982
US

IV. Provider business mailing address

PO BOX 9
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-398-2292
  • Fax:
Mailing address:
  • Phone: 276-398-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230001523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: