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General NPI Number Information
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NPI Number | 1245733021
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Entity Type | Individual
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Provider Name | KRYSTLE DANE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 03/17/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1351 AIRPARK DR
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City | FARMINGTON
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State | MO
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Zip | 63640-2066
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Country | US
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Telephone | 573-760-0333
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Fax | 573-701-0416
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Provider Business Mailing Address
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Address Line | 233 NORMANDIE DR
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City | BONNE TERRE
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State | MO
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Zip | 63628-9215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2008033124
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License Number State | MO
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