Healthcare Provider Details

I. General information

NPI: 1700707783
Provider Name (Legal Business Name): RITA LYNN CROCKETT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W CLAY ST
ROODHOUSE IL
62082-1344
US

IV. Provider business mailing address

127 E PEARL ST
WINCHESTER IL
62694-1140
US

V. Phone/Fax

Practice location:
  • Phone: 217-589-4313
  • Fax: 217-589-5121
Mailing address:
  • Phone: 217-589-4313
  • Fax: 217-589-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-037440
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: