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Crystal Pharmacy LLC

Community/Retail Pharmacy in Moultrie, GA · enumerated 2006 · authorized official Scotty Jarvis, Managing Member.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1790877942

Verified

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Registry record

Entity type Organization (Type 2)
Legal business name Crystal Pharmacy LLC
Other name <Unavail>
Practice address 705 S Main St, Moultrie, GA, 31768
Phone (229) 985-4137
Fax (229) 890-5968
Enumeration date Sep 28, 2006
Last updated in NPPES Nov 25, 2014

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers Secondary
333600000X Pharmacy Suppliers Secondary
3336C0003X Community/Retail Pharmacy Suppliers · License PHRE002206 (GA) Primary

Authorized official

Name Scotty Jarvis
Title Managing Member
Phone (229) 985-4137

Other identifiers

Identifier Type State Issuer
2016008 Other - PK
393761900A Medicaid GA -

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.

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Frequently asked questions

What is the NPI number for Crystal Pharmacy LLC?
The NPI for Crystal Pharmacy LLC is 1790877942, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Crystal Pharmacy LLC?
NPPES lists Scotty Jarvis (Managing Member) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2014-11-25.