Provider Demographics
NPI:1306668975
Name:BEARDSLEY, CRYSTAL (PHARMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BEARDSLEY
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 1:68-1845 WAIKOLOA RD STE 106
Mailing Address - Street 2:PMB 157
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-2630
Mailing Address - Country:US
Mailing Address - Phone:808-747-2977
Mailing Address - Fax:
Practice Address - Street 1:73-5600 MAIAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2630
Practice Address - Country:US
Practice Address - Phone:808-331-4808
Practice Address - Fax:808-331-3861
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIT201024010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist