Healthcare Provider Details

I. General information

NPI: 1831365444
Provider Name (Legal Business Name): KENTON LANCE CROWLEY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 W WARM SPRINGS RD SUITE 109
LAS VEGAS NV
89148-1823
US

IV. Provider business mailing address

40970 ALTON CT
TEMECULA CA
92591-6948
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-1200
  • Fax:
Mailing address:
  • Phone: 626-646-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15858
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38214
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number15858
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number38214
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number15858
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number38214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: