Organization
CRYSTAL PHARMACY LLC
Active
Other names
Crystal Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTTY JARVIS PHARMD (MANAGING MEMBER)
(229) 985-4137
Entity
Organization
Contact information
Practice address
705 SOUTH MAIN ST, MOULTRIE, GA 31768
(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
183500000X
Pharmacist
Primary
2206
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00025605A
—
GA
01
—
1101942
NABP
—
Enumeration date
11/01/2006
Last updated
03/07/2023
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