CRYSTAL PHARMACY LLC (NPI# 1225116239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225116239 |
| Entity Type | Organization |
| Organization Name | CRYSTAL PHARMACY LLC |
| Other Organization Name | CRYSTAL PHARMACY |
| Practice Address |
705 South Main St Moultrie GA 31768 |
| Mailing Address |
Po Box 8 Moultrie GA 31776-0008 |
| Practice Telephone | 2299854137 |
| Practice Fax Number | 2298905968 |
| Mailing Telephone | 2299854137 |
| Mailing Fax Number | 2298905968 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SCOTTY JARVIS (MANAGING MEMBER) |
| Authorized Official Telephone | 2299854137 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 2206 | GA | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NABP | 1101942 | 01 | |
| GA | 00025605A | 05 | |
| DEA | BC9990018 | 01 |
| Other Name | Type Code |
|---|---|
| Crystal Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790877942 | Crystal Pharmacy LLC | Pharmacy | 705 S Main St, Moultrie, GA 31768-5432 | 2006-09-28 |
| Street Address |
705 SOUTH MAIN ST |
| City | MOULTRIE |
| State | GA |
| Zip Code | 31768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649366550 | Jeffrey Scott Jarvis | Pharmacist | 705 South Main St, Moultrie, GA 31768 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356975452 | Zachary Schiffer | Specialist/Technologist | 3131 S Main Street, Moultrie, GA 31768 | 2020-02-27 |
| 1326697731 | Daisy Concierge Care | Nursing Care | 437 S. Morris Rd Lt 1, Moultrie, GA 31768 | 2019-09-09 |
| 1194208751 | Regina Mercer Ward | Nurse Practitioner | 1724 Villa Dr Sw, Moultrie, GA 31768 | 2018-09-10 |
| 1225473630 | Moultrie Orthodontics, P.C. | Clinic/Center | 12 Longleaf Office Park, Moultrie, GA 31768 | 2013-04-30 |
| 1497032239 | Freds Stores of Tennessee Inc | Pharmacy | 2601 South Main Street, Moultrie, GA 31768 | 2011-11-08 |
| 1821382672 | Colquitt Regional Ob/gyn, LLC | Obstetrics & Gynecology | 3 Sweet Bay Ct, Moultrie, GA 31768 | 2011-06-08 |
| 1568779809 | Shana Goodno | Nurse Practitioner | 207 31 St Ave Se, Moultrie, GA 31768 | 2010-09-08 |
| 1508177445 | Cherokee Rose Emergency Physicians | Emergency Medicine | 3131 South Main Street, Moultrie, GA 31768 | 2010-06-25 |
| 1023299963 | Hetal Patel | Counselor | 600 2nd St South East, Moultrie, GA 31768 | 2007-11-20 |
| 1720146756 | William C Byrd Inc | Assisted Living Facility | 498 5th Street Se, Moultrie, GA 31768 | 2006-12-04 |
| Find all providers in zip 31768 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568839959 | Mark Niday | Pharmacist | 382 Rufus Murphy Rd, Moultrie, GA 31768-0555 | 2015-09-01 |
| 1225327778 | Norris Cooper | Pharmacist | 305 6th St Se, Moultrie, GA 31768-4842 | 2011-04-06 |
| 1740488600 | Michael Brandon Griffin | Pharmacist | 103 Talmadge Dr, Moultrie, GA 31768-5050 | 2007-07-03 |
| 1649366550 | Jeffrey Scott Jarvis | Pharmacist | 705 South Main St, Moultrie, GA 31768 | 2006-10-05 |
| 1780770222 | Fred Eugene Purvis | Pharmacist | Winn Dixie 101, 103 Talmadge Dr, Moultrie, GA 31768 | 2006-10-04 |
| 1033719174 | Alexandreia Taylor Bassett | Pharmacist | 641 Veterans Pkwy S, Moultrie, GA 31788-8843 | 2020-10-28 |
| 1073113429 | Daniel Rustin Dixon | Pharmacist | 641 Veterans Pkwy S, Moultrie, GA 31788-8843 | 2020-10-27 |
| 1528674439 | Lindsay Mobley | Pharmacist | 378 Veterans Pkwy N, Moultrie, GA 31788-4171 | 2020-09-17 |
| 1376168518 | Dong Hyun Kim | Pharmacist | 1027 S Main St, Moultrie, GA 31768-5438 | 2020-06-13 |
| 1346727955 | Courtney Foy Edwards | Pharmacist | 378 Veterans Pkwy N, Moultrie, GA 31788-4171 | 2018-07-26 |
| Find all providers in MOULTRIE | ||||
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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.