MEDICARE: DR. CRYSTAL BUI PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	64030	TX

General Provider Information

NPI Number	:	1083275036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL BUI PHARMD.

Provider Business Mailing Address
First Line	:	305 PALM SHORES DR APT A104
Second Line	:
City	:	LA JOYA
State	:	TX
Zip	:	78560-4300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5326 E US HIGHWAY 83 STE A
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-9409
Country	:	US
Telephone Number	:	956-317-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	06/20/2019

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