Provider Demographics
NPI:1699285056
Name:BARNES, CRYSTAL LEIGH
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEIGH
Last Name:BARNES
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 1:310 CHARLIE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273-1103
Mailing Address - Country:US
Mailing Address - Phone:903-564-1234
Mailing Address - Fax:903-564-1238
Practice Address - Street 1:310 CHARLIE ST
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-1103
Practice Address - Country:US
Practice Address - Phone:903-564-1234
Practice Address - Fax:903-564-1238
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist