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Organization
CRYSTAL PHARMACY LLC
Active
Organization
CRYSTAL PHARMACY LLC
Active
Other names
CRYSTAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTTY JARVIS PHRMD (MANAGING MEMBER)
(229) 985-4137
Entity
Organization
Contact information
Practice address
705 S MAIN ST, MOULTRIE, GA 31768-5432
(229) 985-4137
(229) 890-5968
Mailing address
PO BOX 8, MOULTRIE, GA 31776-0008
(229) 985-4137
(229) 890-5968
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE002206
GA
Other
Enumeration date
09/28/2006
Last updated
11/25/2014
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