Healthcare Provider Details

I. General information

NPI: 1902939457
Provider Name (Legal Business Name): JOSHUA GLEN CROWLEY PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 BOSTON RD
MONTICELLO KY
42633-8321
US

IV. Provider business mailing address

465 BOSTON RD
MONTICELLO KY
42633-8321
US

V. Phone/Fax

Practice location:
  • Phone: 606-341-3518
  • Fax:
Mailing address:
  • Phone: 606-341-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012947
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: