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NPI Code Detail

MEDICARE: CRYSTAL HOME HEALTHCARE PHCY

MEDICARE: CRYSTAL HOME HEALTHCARE PHCY
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
1333600000XPharmacy5301008320MI
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12368086OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1255346870
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRYSTAL HOME HEALTHCARE PHCY
Provider Business Mailing Address
First Line : 15819 SCHOOLCRAFT ST
Second Line :
City : DETROIT
State : MI
Zip : 48227-1749
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15819 SCHOOLCRAFT ST
Second Line :
City : DETROIT
State : MI
Zip : 48227-1749
Country : US
Telephone Number : 313-493-4900
Fax Number : 313-493-4904
Authorized Official
Title or Position : PHCY MGR
Name : JONATHAN ADAMS
Credential : RPH
Telephone Number : 313-493-4900
Provider Enumeration Date : 07/30/2006
Last Update Date : 09/11/2025

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Directions to “CRYSTAL HOME HEALTHCARE PHCY ” Practice Location

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