Active NPI
Crystal Mayola Wyrick, RPH
- Pharmacist
- Stevenson, WA
National Provider Identifier
1760614879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60064475
- Practice address
- 280 SW 2ND St
Stevenson, WA 98648-4226 - Phone
- (509) 427-5480
- Fax
- (509) 427-7807
- NPI assigned
- Aug 23, 2009
- Last updated
- Jun 14, 2022
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0011491 | OR | |
| Pharmacist | 183500000X | 14004 | NC | |
| Pharmacist | 183500000X | PH60064475 | WA | Primary |
Addresses
Primary practice location
280 SW 2ND St
Stevenson, WA 98648-4226
Mailing address
916 W Evergreen Blvd
Vancouver, WA 98660-3035
Phone (360) 213-2236
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14004 | NC | MD | Pharmacist |
| RPH-0011491 | OR | MD | Pharmacist |
| PH60064475 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| WRP, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655164800000",
"number": "1760614879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "916 W EVERGREEN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986603035",
"telephone_number": "360-213-2236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 SW 2ND ST",
"city": "STEVENSON",
"state": "WA",
"postal_code": "986484226",
"telephone_number": "509-427-5480",
"fax_number": "509-427-7807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYRICK",
"first_name": "CRYSTAL",
"middle_name": "MAYOLA",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-23",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0011491",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "14004",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60064475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stevenson, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.