Provider Demographics
NPI:1316608490
Name:SARTUCHE, CRYSTAL CAREY
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CAREY
Last Name:SARTUCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WHITLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2226
Mailing Address - Country:US
Mailing Address - Phone:559-992-8020
Mailing Address - Fax:559-992-3881
Practice Address - Street 1:1500 WHITLEY AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2226
Practice Address - Country:US
Practice Address - Phone:559-992-8020
Practice Address - Fax:559-992-3881
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161718183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician