Active NPI
Crystal Naoum
- Pharmacist
- San Diego, CA
National Provider Identifier
1689341554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 85404
- Practice address
- 5555 Reservoir Dr Ste 114
San Diego, CA 92120-5197 - Phone
- (619) 996-0619
- Fax
- (619) 877-0110
- NPI assigned
- Aug 27, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.023969 | LA | |
| Pharmacist | 183500000X | 85404 | CA | Primary |
Addresses
Primary practice location
5555 Reservoir Dr Ste 114
San Diego, CA 92120-5197
Mailing address
5555 Reservoir Dr Ste 114
San Diego, CA 92120-5197
Phone (619) 996-0619
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.023969 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richmond Pharmacy, Inc. | Current | Accepting new patients | |
| Alvarado Pharmacy SD | Current | Accepting new patients |
Locations
5555 Reservoir Dr
Ste 114
San Diego, CA 92120
Phone (619) 287-5035
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- San Diego, CA
- NPI 1376318345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1689341554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5555 RESERVOIR DR STE 114",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921205197",
"telephone_number": "619-996-0619",
"fax_number": "619-877-0110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5555 RESERVOIR DR STE 114",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921205197",
"telephone_number": "619-996-0619",
"fax_number": "619-877-0110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAOUM",
"first_name": "CRYSTAL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-27",
"last_updated": "2024-01-30",
"certification_date": "2024-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.023969",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "85404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.