MEDICARE: CRYSTAL M NEIDIGH

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	02020009069	VA

General Provider Information

NPI Number	:	1811291396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL M NEIDIGH

Provider Business Mailing Address
First Line	:	915 HARDY RD
Second Line	:
City	:	VINTON
State	:	VA
Zip	:	24179-3643
Country	:	US
Telephone Number	:	540-344-1215
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 HARDY RD
Second Line	:
City	:	VINTON
State	:	VA
Zip	:	24179-3643
Country	:	US
Telephone Number	:	540-344-1215
Fax Number	:

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

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	12/27/2010

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Directions to “ CRYSTAL M NEIDIGH ” Practice Location

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