Individual
CRYSTAL GAIL MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.PH.T
Contact information
Practice address
111 W. KINGSTON SPRINGS RD, STE 103, KINGSTON SPRINGS, TN 37082
(615) 952-3690
(615) 952-3692
Mailing address
PO BOX 420, BON AQUA, TN 37025-0420
(615) 412-3001
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
14104
TN
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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