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General NPI Number Information
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NPI Number | 1790015345
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Entity Type | Organization
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Legal Business Name | CRYSTAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 9351 LAKESIDE BLVD STE 103
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5063
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Country | US
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Telephone | 410-363-8222
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Fax | 410-363-2133
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Provider Business Mailing Address
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Address Line | 9151 REISTERSTOWN RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4503
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Country | US
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Telephone | 410-363-8222
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Fax | 410-363-2133
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MANOJNA CHALASANI
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Credential |
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Telephone | 410-963-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P05168
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License Number State | MD
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