NPIMap

Organization Active NPI

Chrystal Inc

  • Community/Retail Pharmacy
  • Cookeville, TN
National Provider Identifier
1962494385
Registry record updated Jan 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2271 Issued in TN
Legal business name
CHRYSTAL INC
Practice address
100 W 3Rd St
Cookeville, TN 38501-2495
Phone
(931) 526-4312
NPI assigned
Aug 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2011

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

Authorized official

Name
Clarence Smith, RPHNPI 1255323689
Title
President
Phone
(931) 526-4612

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 2271 TN Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

100 W 3Rd St
Cookeville, TN 38501-2495

Mailing address

PO Box 2707
Cookeville, TN 38502-2707
Phone (931) 260-9589

Other identifiers 2

IdentifierTypeStateIssuer
3561654MedicaidTN
4426602OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • SMITH PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

100 W 3rd St
Ste A
Cookeville, TN 38501
Phone (931) 526-4612

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296000000000",
    "number": "1962494385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2707",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385022707",
            "telephone_number": "931-260-9589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 3RD ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012495",
            "telephone_number": "931-526-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2011-01-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-526-4612",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "2271",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3561654",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4426602",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMITH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; 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.