Provider Demographics
NPI:1679148613
Name:PUTT, CRYSTAL JANICE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JANICE
Last Name:PUTT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 W NORTH UNION RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9585
Mailing Address - Country:US
Mailing Address - Phone:989-402-7664
Mailing Address - Fax:989-835-1984
Practice Address - Street 1:910 JOE MANN BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8903
Practice Address - Country:US
Practice Address - Phone:989-835-6364
Practice Address - Fax:989-835-1984
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303015830183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician