Healthcare Provider Details

I. General information

NPI: 1215990916
Provider Name (Legal Business Name): IRENE CROSWELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N PACIFIC HWY SAFEWAY PHARMACY #1976
WOODBURN OR
97071-3622
US

IV. Provider business mailing address

1550 N PACIFIC HWY SAFEWAY PHARMACY #1976
WOODBURN OR
97071-3622
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-2864
  • Fax: 503-982-2868
Mailing address:
  • Phone: 503-982-2864
  • Fax: 503-982-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9231
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11671
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberOR0009231
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: