Provider Demographics
NPI:1386261113
Name:OLBERDING, CRYSTAL (RPH)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:OLBERDING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 LORAIN RD APT 302
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3430
Mailing Address - Country:US
Mailing Address - Phone:440-655-9732
Mailing Address - Fax:
Practice Address - Street 1:520 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2724
Practice Address - Country:US
Practice Address - Phone:440-232-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist