Active NPI
Brock Crystal, PHARMD
- Pharmacist
- Brigham City, UT
National Provider Identifier
1316601420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5892974-1701
- Practice address
- 1017 Medical Dr
Brigham City, UT 84302-3049 - Phone
- (435) 723-5211
- Fax
- (435) 723-6379
- NPI assigned
- Oct 25, 2021
- Sex
- Male
- 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 | 5892974-1701 | UT | Primary |
Addresses
Primary practice location
1017 Medical Dr
Brigham City, UT 84302-3049
Mailing address
1017 Medical Dr
Brigham City, UT 84302-3049
Phone (435) 723-5211
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 |
|---|---|---|---|
| 5892974-1701 | UT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635206400000",
"number": "1316601420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 MEDICAL DR",
"city": "BRIGHAM CITY",
"state": "UT",
"postal_code": "843023049",
"telephone_number": "435-723-5211",
"fax_number": "435-723-6379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1017 MEDICAL DR",
"city": "BRIGHAM CITY",
"state": "UT",
"postal_code": "843023049",
"telephone_number": "435-723-5211",
"fax_number": "435-723-6379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRYSTAL",
"first_name": "BROCK",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-25",
"last_updated": "2021-10-26",
"certification_date": "2021-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "5892974-1701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brigham City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.