Active NPI
Andrea Crismon, PHARMD
- Pharmacist
- Poplar Bluff, MO
National Provider Identifier
1124294269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2005040268
- Practice address
- 2002 Kanell Blvd Ste 102
Poplar Bluff, MO 63901-4011 - Phone
- (573) 778-1608
- NPI assigned
- May 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2005040268 | MO | Primary |
Addresses
Primary practice location
2002 Kanell Blvd Ste 102
Poplar Bluff, MO 63901-4011
Mailing address
2002 Kanell Blvd Ste 102
Poplar Bluff, MO 63901-4011
Phone (573) 778-1608
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005040268 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717545600000",
"number": "1124294269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 KANELL BLVD STE 102",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639014011",
"telephone_number": "573-778-1608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2002 KANELL BLVD STE 102",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639014011",
"telephone_number": "573-778-1608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRISMON",
"first_name": "ANDREA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-07",
"last_updated": "2024-06-05",
"certification_date": "2024-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2005040268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.