Provider Demographics
NPI:1316482466
Name:DENAYER, CRYSTAL (PHARMD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DENAYER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:CANLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:951 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1693
Mailing Address - Country:US
Mailing Address - Phone:510-676-2577
Mailing Address - Fax:
Practice Address - Street 1:655 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3546
Practice Address - Country:US
Practice Address - Phone:530-756-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist