Healthcare Provider Details

I. General information

NPI: 1093066342
Provider Name (Legal Business Name): WILLIAM MARSHALL CRABTREE III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5639 HOOD ST
WEST LINN OR
97068-3235
US

IV. Provider business mailing address

5639 HOOD ST
WEST LINN OR
97068-3235
US

V. Phone/Fax

Practice location:
  • Phone: 509-607-4673
  • Fax: 503-650-7855
Mailing address:
  • Phone: 509-607-4673
  • Fax: 503-650-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPI-0010778
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR 60281819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: