Provider Demographics
NPI:1922990738
Name:CRISMON, MILES LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:LYNN
Last Name:CRISMON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 MURMURING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-2923
Mailing Address - Country:US
Mailing Address - Phone:512-663-5068
Mailing Address - Fax:
Practice Address - Street 1:9600 MURMURING CREEK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-2923
Practice Address - Country:US
Practice Address - Phone:512-663-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220351835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric