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General NPI Number Information
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NPI Number | 1003410796
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Entity Type | Individual
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Provider Name | WILLIAM CLARK CROWDER JR. DPH
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 246 E GAINES ST
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3343
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Country | US
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Telephone | 931-762-0800
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Fax | 931-762-4939
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Provider Business Mailing Address
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Address Line | 198 WALDEN RD
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-3094
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Country | US
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Telephone | 931-629-3693
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Fax | 931-762-4939
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6263
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License Number State | TN
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