Healthcare Provider Details

I. General information

NPI: 1982681714
Provider Name (Legal Business Name): C. SUSAN CROSSLAND RPH, CACP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE SUITE A 201
TACOMA WA
98405-1702
US

IV. Provider business mailing address

9859 MIAMI BEACH RD NW
SEABECK WA
98380-9707
US

V. Phone/Fax

Practice location:
  • Phone: 253-459-6736
  • Fax: 253-459-6238
Mailing address:
  • Phone: 360-830-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00009687
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: