Krystal R Clemmons

Key facts

NPI

1265196174

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacy Technician 183700000X

Practice address

2519 Main St
Union Gap, WA 98903-1605

Phone

(509) 453-3603

NPI assigned

Oct 26, 2021

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 26, 2021.

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1265196174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 MAIN ST",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031605",
            "telephone_number": "509-453-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 MAIN ST",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031605",
            "telephone_number": "509-453-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMMONS",
        "first_name": "KRYSTAL",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "customer.service@riteaid.com",
            "affiliation": "N",
            "address_1": "2519 Main St",
            "city": "Union Gap",
            "state": "WA",
            "country_code": "US",
            "postal_code": "989031605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in Union Gap, WA · Pharmacy Technician in Washington