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General NPI Number Information
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NPI Number | 1912761388
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Entity Type | Individual
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Provider Name | CRYSTAL MIN
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Gender | Female
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 2101 W IMPERIAL HWY
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City | LA HABRA
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State | CA
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Zip | 90631-6302
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Country | US
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Telephone | 562-947-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 292 N DALTON DR
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City | ANAHEIM
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State | CA
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Zip | 92807-2954
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Country | US
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Telephone | 909-677-9433
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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 | 89086
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License Number State | CA
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