Healthcare Provider Details

I. General information

NPI: 1417462870
Provider Name (Legal Business Name): JESSICA R CROW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

712 CHAMBERS CIR
BEL AIR MD
21014-3428
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-5702
  • Fax:
Mailing address:
  • Phone: 806-433-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number18920
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: