Provider Demographics
NPI:1194331694
Name:MOUA, CRYSTAL BRIGHT (PHARMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:BRIGHT
Last Name:MOUA
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 1:722 N CLOVIS AVE APT 155
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0364
Mailing Address - Country:US
Mailing Address - Phone:530-514-9256
Mailing Address - Fax:
Practice Address - Street 1:4224 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-7120
Practice Address - Country:US
Practice Address - Phone:559-229-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist