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General NPI Number Information
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NPI Number | 1467979971
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 444 N MAIN ST FL 1
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City | AKRON
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State | OH
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Zip | 44310-3110
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Country | US
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Telephone | 330-379-5125
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Fax | 330-379-9086
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Provider Business Mailing Address
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Address Line | 444 N MAIN ST FL 1
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City | AKRON
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State | OH
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Zip | 44310-3110
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Country | US
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Telephone | 330-379-5125
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Fax | 330-379-9086
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Authorized Official
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Title or Position | MANAGER PHARMACY OPERATIONS
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Name | PATRICIA E WALDER
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Credential | RPH
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Telephone | 330-379-5125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PMY02264650-03
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License Number State | OH
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