Individual
CRYSTAL DOMINIQUE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5901 U S HIGHWAY 49, HATTIESBURG, MS 39402-2858
(601) 296-9566
Mailing address
647 E I 10 SERVICE RD STE 142, SLIDELL, LA 70461-5511
(504) 221-3840
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
019781
LA
183500000X
Pharmacist
Primary
E-12071
MS
Other
Enumeration date
10/07/2020
Last updated
10/07/2020
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