Provider Demographics
NPI:1962775940
Name:ANDERSON, CRYSTAL NICHOLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICHOLE
Last Name:ANDERSON
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 1:7701 DEBARR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1845
Mailing Address - Country:US
Mailing Address - Phone:907-269-1733
Mailing Address - Fax:907-269-1727
Practice Address - Street 1:7701 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1845
Practice Address - Country:US
Practice Address - Phone:907-269-1733
Practice Address - Fax:907-269-1727
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1626183500000X
AKPHAP16261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist