Crystal Mayola Wyrick, RPH
Individual provider Active NPI Pharmacist · Stevenson, WA
NPI 1760614879 · NPPES record last updated Jun 14, 2022
Key facts
- NPI
- 1760614879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PH60064475 (WA)
- Practice address
- 280 SW 2ND St
Stevenson, WA 98648-4226 - Phone
- (509) 427-5480
- Fax
- (509) 427-7807
- NPI assigned
- Aug 23, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0011491 | OR | MD | Pharmacist |
| PH60064475 | WA | MD | Pharmacist |
| 14004 | NC | MD | Speech-Language Pathologist |
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 |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0011491 | OR | |
| Pharmacist | 183500000X | 14004 | NC | |
| Pharmacist | 183500000X | PH60064475 | WA | Yes |
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
Other providers in Stevenson, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 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.