Crystal Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE002206 Issued in GA

Legal business name

CRYSTAL PHARMACY LLC

Doing business as

Crystal Pharmacy

Practice address

705 S Main St
Moultrie, GA 31768-5432

Phone

(229) 985-4137

Fax

(229) 890-5968

NPI assigned

Sep 28, 2006

Last updated

Nov 25, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Scotty Jarvis, PHRMD

Title

Managing Member

Phone

(229) 985-4137

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• CRYSTAL PHARMACY Doing business as

Tax ID family

Crystal Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Crystal Pharmacy LLC

  dba Crystal Pharmacy

  • Pharmacist
  • Moultrie, GA
  • NPI 1225116239
  NPD tax ID
• Crystal Pharmacy, LLC

  • Pharmacist
  • Moultrie, GA
  • NPI 1700897659
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1790877942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317760008",
            "telephone_number": "229-985-4137",
            "fax_number": "229-890-5968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685432",
            "telephone_number": "229-985-4137",
            "fax_number": "229-890-5968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "JARVIS",
        "authorized_official_first_name": "SCOTTY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "229-985-4137",
        "authorized_official_credential": "PHRMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE002206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "393761900A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2016008",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRYSTAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renee Wilson Crosby
• Terrence Croyle, M.D.
• Tre'Cherie Arachael Crumbs, MD
• Mailyn Cruz
• Crystal Pharmacy LLC (Crystal Pharmacy)
• Crystal Pharmacy, LLC
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• Dale L. McGregor, D.O., P.C.
• Scott Fitzgerald Daly, MD

• Community/Retail Pharmacy in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.