MEDICARE: DR. WILLIAM MARSHALL CRABTREE III PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PI-0010778	OR
2	183500000X	Pharmacist	IR 60281819	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IR 60281819	OTHER	WA	STATE PHARMACY INTERN LICENSE
2	RPH-0013722	OTHER	OR	OR BOARD OF PHARMACY

General Provider Information

NPI Number	:	1093066342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MARSHALL CRABTREE III PHARMD

Provider Business Mailing Address
First Line	:	5639 HOOD ST
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3235
Country	:	US
Telephone Number	:	509-607-4673
Fax Number	:	503-650-7855

Provider Business Practice Location Address
First Line	:	5639 HOOD ST
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3235
Country	:	US
Telephone Number	:	509-607-4673
Fax Number	:	503-650-7855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	03/14/2014

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