Provider Demographics
NPI:1114739935
Name:PRESTON, KRYSTAL MONIQUE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MONIQUE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:833-367-6699
Mailing Address - Fax:
Practice Address - Street 1:9449 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2325
Practice Address - Country:US
Practice Address - Phone:833-367-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist