Crystal L Gedris, PHARMD
Individual provider Active NPI Pharmacist · Wood River, IL
NPI 1689397937 · NPPES record last updated Sep 21, 2022
Key facts
- NPI
- 1689397937
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051-292722 (IL)
- Practice address
- 1 W Edwardsville Rd
Wood River, IL 62095-1261 - Phone
- (618) 254-3610
- NPI assigned
- Sep 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 051-292722 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS, L.L.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051-292722 | IL | Yes |
Addresses
Primary practice location
1 W Edwardsville Rd
Wood River, IL 62095-1261
Mailing address
1 W Edwardsville Rd
Wood River, IL 62095-1261
Phone (618) 254-3610
Other providers in Wood River, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2022. 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.