| NPI | 1285928473 |
|---|---|
| Former Name | CRYSTAL MARIE MCCOY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6581) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5825725) |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2015-07-10 |