Provider Demographics
NPI:1861094443
Name:DEL BOSQUE, CRYSTAL SAAVEDRA
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:SAAVEDRA
Last Name:DEL BOSQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:SAAVEDRA
Other - Last Name:DEL BOSQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:139 E COUNTY ROAD 2155
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-9709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1133 E GENERAL CAVAZOS BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7142
Practice Address - Country:US
Practice Address - Phone:361-595-5429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist