Provider Demographics
NPI:1124499116
Name:WALSH, CRYSTAL ROSE (PHARM D)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ROSE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PEQUOT RUN
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1994
Mailing Address - Country:US
Mailing Address - Phone:401-451-1747
Mailing Address - Fax:
Practice Address - Street 1:9 PEQUOT RUN
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1994
Practice Address - Country:US
Practice Address - Phone:401-451-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist