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General NPI Number Information
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NPI Number | 1710765821
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Entity Type | Organization
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Legal Business Name | CRYSTAL PHARMACY
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 174 HOSPITAL DR
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City | RATON
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State | NM
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Zip | 87740-2002
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Country | US
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Telephone | 505-363-3434
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Fax | 575-445-4899
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Provider Business Mailing Address
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Address Line | 174 HOSPITAL DR
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City | RATON
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State | NM
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Zip | 87740-2002
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Country | US
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Telephone | 575-395-7559
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Fax | 575-396-1049
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | CHARLES EMMANUEL BARKLEY
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Credential | RPH
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Telephone | 575-395-7559
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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