MEDICARE: KRYSTAL HENRY

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	PS42876	FL

General Provider Information

NPI Number	:	1386921542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL HENRY

Provider Business Mailing Address
First Line	:	8200 ROYAL PALM BLVD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 ROYAL PALM BLVD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5714
Country	:	US
Telephone Number	:	954-341-5977
Fax Number	:

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	04/06/2017

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