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General NPI Number Information
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NPI Number | 1396600342
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Entity Type | Organization
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Legal Business Name | CRYSTAL HEALTH SOLUTIONS MICHIGAN LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 160 CUTLER DR STE 300
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2967
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Country | US
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Telephone | 801-854-7347
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Fax |
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Provider Business Mailing Address
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Address Line | 721 N MAIN ST STE 220
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City | LAYTON
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State | UT
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Zip | 84041-2231
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Country | US
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Telephone | 801-854-7347
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JACOB C MOENCH
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Credential |
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Telephone | 385-368-6377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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