MEDICARE: DR. KENTON LANCE CROWLEY PHARM.D.

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	15858	NV
2	183500000X	Pharmacist	38214	CA
3	1835N1003X	Nutrition Support Pharmacist	15858	NV
4	1835N1003X	Nutrition Support Pharmacist	38214	CA
5	1835P1200X	Pharmacotherapy Pharmacist	15858	NV
6	1835P1200X	Pharmacotherapy Pharmacist	38214	CA

General Provider Information

NPI Number	:	1831365444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENTON LANCE CROWLEY PHARM.D.

Provider Business Mailing Address
First Line	:	40970 ALTON CT
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-6948
Country	:	US
Telephone Number	:	626-646-3227
Fax Number	:

Provider Business Practice Location Address
First Line	:	8785 W WARM SPRINGS RD
Second Line	:	SUITE 109
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1823
Country	:	US
Telephone Number	:	702-731-1200
Fax Number	:

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

Provider Enumeration Date	:	05/03/2008
Last Update Date	:	10/22/2009

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