Krystal Edge Grimes, PHARMD
Individual provider Active NPI Pharmacist · Beebe, AR
NPI 1669074233 · NPPES record last updated Nov 9, 2020
Key facts
- NPI
- 1669074233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD12792 (AR)
- Practice address
- 2003 W Center St
Beebe, AR 72012-2544 - Phone
- (501) 882-1516
- NPI assigned
- Nov 9, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD12792 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past |
Accepting new patients | |
| Walmart Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD12792 | AR | Yes |
Addresses
Primary practice location
2003 W Center St
Beebe, AR 72012-2544
Mailing address
46 N Beryl Rd
Vilonia, AR 72173-9719
Other providers in Beebe, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.