=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013927987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY CROSBY CRABB RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1826 VETERANS BLVD PHARMACY 119
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-277-2737
-----------------------------------------------------
Fax | 478-277-2716
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 PARKS RDG
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-2973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-275-2329
-----------------------------------------------------
Fax | 478-277-2716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10797
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------