Provider Demographics
NPI:1053533984
Name:HEMBREE, CRYSTAL HOLMES (CPHT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:HOLMES
Last Name:HEMBREE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MICHELLE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 S CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2627
Mailing Address - Country:US
Mailing Address - Phone:678-858-7362
Mailing Address - Fax:
Practice Address - Street 1:406 COURTHOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113
Practice Address - Country:US
Practice Address - Phone:770-646-3570
Practice Address - Fax:770-646-3571
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician