Healthcare Provider Details

I. General information

NPI: 1568761450
Provider Name (Legal Business Name): MARYLOU CROWLEY R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 MAW BRIDGE RD
CENTRAL SC
29630-8950
US

IV. Provider business mailing address

2445 MAW BRIDGE RD
CENTRAL SC
29630-8950
US

V. Phone/Fax

Practice location:
  • Phone: 864-506-9023
  • Fax:
Mailing address:
  • Phone: 864-506-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17937
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11423
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: