Crystal Pharmacy
LBN: Crystal Pharmacy Llc
Crystal Pharmacy is an health care organization with primary practice located at 705 S Main St , Moultrie GA 31768-5432. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Crystal Pharmacy Llc can be contacted via phone (229) 985-4137, or through Jarvis, Scotty via phone (229) 985-4137.
Contact Information
Primary practice address
705 S Main St
Moultrie GA 31768-5432
Phone: (229) 985-4137
Fax: (229) 890-5968
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | PHRE002206 | Georgia |
Profile Details
| NPI number | 1790877942 |
|---|---|
| LBN Legal business name | Crystal Pharmacy Llc |
| DBA Doing business as | Crystal Pharmacy |
| Authorized official | Jarvis, Scotty PHRMD |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 28th, 2006 |
| Last updated | Nov 25th, 2014 - about 10 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790877942 | NPPES |
| Other | 2016008 | PK | |
| MEDICAID | 393761900A | PK |
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