Healthcare Provider Details

I. General information

NPI: 1205068756
Provider Name (Legal Business Name): LAWRENCE WILLIAM CROWLEY R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N IOWA ST
DODGEVILLE WI
53533-1548
US

IV. Provider business mailing address

114 W WALNUT ST
DODGEVILLE WI
53533-1659
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-3661
  • Fax: 608-935-2661
Mailing address:
  • Phone: 608-935-5189
  • Fax: 608-935-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11568-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: