Individual
KRYSTAL LYNN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
6096 W PARK AVE, HOUMA, LA 70364-1808
(985) 876-2584
(985) 876-5050
Mailing address
6096 W PARK AVE, HOUMA, LA 70364-1808
(985) 876-2584
(985) 876-5050
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
6462
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6462PT
BOARD OF PHARMACY LIC# 6462PT
LA
Enumeration date
11/02/2018
Last updated
11/02/2018
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