KRYSTAL LYNN ELLIS (NPI# 1124596630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124596630 |
| Entity Type | Individual |
| Full Name | KRYSTAL LYNN ELLIS |
| Credential | CPHT |
| Practice Address |
6096 W Park Ave Houma LA 70364-1808 |
| Practice Telephone | 9858762584 |
| Practice Fax Number | 9858765050 |
| Mailing Telephone | 9858762584 |
| Mailing Fax Number | 9858765050 |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183700000X | Pharmacy Technician | 6462 | LA | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | BOARD OF PHARMACY LIC# 6462PT | 6462PT | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962904482 | Krystal Ellis | Chore Provider | 6725 S Eastern Ave Ste 1, Las Vegas, NV 89119-3949 | 2018-02-28 |
| Street Address |
6096 W PARK AVE |
| City | HOUMA |
| State | LA |
| Zip Code | 70364-1808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417026360 | Broadmoor Drug Center Inc | Pharmacy | 6096 W Park Ave, Houma, LA 70364-1808 | 2006-11-07 |
| 1538307210 | Curtis Joseph Badeaux Jr. | Pharmacist | 6096 W Park Ave, Houma, LA 70364-1808 | 2009-02-03 |
| 1679625800 | Dean Patrick Pellegrin | Pharmacist | 6096 W Park Ave, Houma, LA 70364-1808 | 2007-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922669183 | Pelican State Home and Community Services | Home Health Aide | 154 B South Hollywood Road, Houma, LA 70364 | 2019-06-27 |
| 1356708820 | Mmg Healthcare Services,llc | Home Health | 505 Holiday Dr, Houma, LA 70364 | 2016-01-28 |
| 1477894384 | Jacqueline B Spencer | Counselor | 249 T. Leigh Drive, Houma, LA 70364 | 2013-03-04 |
| 1497015622 | Compass Behavioral Center of Houma, LLC | Psychiatric Hospital | 4701 W Park Ave, Houma, LA 70364 | 2012-05-22 |
| 1629233994 | Elizabeth Billiot Cooper | Counselor | 409 Garnet St, Houma, LA 70364 | 2008-07-25 |
| 1306968524 | Septime Joseph Hymel Jr. | Optometrist | 5953 West Park Ave, Suite 2000, Houma, LA 70364 | 2007-04-06 |
| 1144348723 | The Therapy Group, LLC | Clinic/Center | 7843 Park Ave, Houma, LA 70364 | 2007-03-26 |
| 1437296142 | Keith M Lane | Dentist | 7024 Park Ave, Houma, LA 70364 | 2007-01-31 |
| 1376697706 | Janice Brownlee Naquin | Dentist | 114 Westside Blvd, Houma, LA 70364 | 2007-01-23 |
| 1093816167 | Jason Wonch Od and Associates Apc | Eyewear Supplier (Equipment, not the service) | 5953 West Park Avenue, Houma, LA 70364 | 2006-09-25 |
| Find all providers in zip 70364 | ||||
| Taxonomy Code | 183700000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacy Technician |
| A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |
| Notes: Source: Pharmacy Technician Certification Board, www.ptcb.org [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730793704 | Joycelyn Glenn | Pharmacy Technician | 1549 Gentilly Blvd, New Orleans, LA 70119-2254 | 2020-09-07 |
| 1477041408 | Beth Nicole Shelton | Pharmacy Technician | 2106 Bert Kouns Industrial Loop, Shreveport, LA 71118-3317 | 2018-04-25 |
| 1861939142 | Rebecca Falcon | Pharmacy Technician | 5341 Myrle St, Addis, LA 70710-2422 | 2017-01-25 |
| 1285998864 | Preston Cantrelle | Pharmacy Technician | 5259 Marcia Ave, New Orleans, LA 70124-1048 | 2012-06-28 |
| 1417162702 | Barbara Jean Collins | Pharmacy Technician | 1027 St. Helena St., Clinton, LA 70722 | 2007-05-11 |
| 1902022205 | Christine Cruz Lee | Pharmacy Technician | 56449 Redmill Dr, Slidell, LA 70461-1327 | 2007-04-17 |
| 1730209164 | Kathy E Denman | Pharmacy Technician | 204 Davenport Ave., Mer Rouge, LA 71261 | 2007-03-30 |
| 1215963665 | Sunset Pharmacy, Inc | Pharmacy Technician | 919 Napoleon Ave, Sunset, LA 70584-6100 | 2006-06-25 |
| 1528028131 | Karen Michelle Seffens | Pharmacy Technician | 252 Highway 132, Mangham, LA 71259-5268 | 2006-03-27 |
| 1255945382 | Frank James List | Pharmacy Technician | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.