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General NPI Number Information
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NPI Number | 1962494385
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Entity Type | Organization
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Legal Business Name | CHRYSTAL INC
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 100 W 3RD ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-2495
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Country | US
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Telephone | 931-526-4312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2707
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City | COOKEVILLE
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State | TN
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Zip | 38502-2707
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Country | US
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Telephone | 931-260-9589
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARENCE SMITH
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Credential | RPH
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Telephone | 931-526-4612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2271
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License Number State | TN
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