Healthcare Provider Details

I. General information

NPI: 1215011309
Provider Name (Legal Business Name): DR. LAMONICA NICOLE CRUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PARK CREEK DR
GREENVILLE SC
29605-4270
US

IV. Provider business mailing address

302 SYCAMORE RIDGE DR
SIMPSONVILLE SC
29681-4068
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1600
  • Fax:
Mailing address:
  • Phone: 864-884-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number009159
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: