Crystal Pharmacy LLC
Crystal Pharmacy LLC is a healthcare organization registered as Community/Retail Pharmacy in Moultrie, GA, holding Type 2 (organization) NPI 1790877942 since 2006. The authorized official on file is Scotty Jarvis, Managing Member.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1790877942 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Crystal Pharmacy LLC |
| Other name | <Unavail> |
| Practice address | 705 S MAIN ST, Moultrie, GA, 31768 |
| Phone | 2299854137 |
| Fax | 2298905968 |
| Enumeration date | 2006-09-28 |
| Last updated in NPPES | 2014-11-25 |
Authorized official
| Name | Scotty Jarvis |
|---|---|
| Title | Managing Member |
| Phone | 2299854137 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 332B00000X | Durable Medical Equipment & Medical Supplies | Secondary | — | — |
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | PHRE002206 | GA |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2016008 | Other | — | PK |
| 393761900A | Medicaid | GA | — |
Copy-ready billing details
Provider: Crystal Pharmacy LLC NPI: 1790877942 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 705 S MAIN ST, Moultrie, GA, 31768
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1700897659 | Crystal Pharmacy, LLC | Organization | Pharmacist | Moultrie, GA |
Verify this record
Cross-check NPI 1790877942 against the authoritative CMS record: view Crystal Pharmacy LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Crystal Pharmacy LLC?
Who is the authorized official for Crystal Pharmacy LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2014-11-25.