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General NPI Number Information
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NPI Number | 1073875183
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Entity Type | Individual
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Provider Name | DAVID EDWARD CROWDER RPH
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Gender | Male
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 450 WHITE SPAR RD
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City | PRESCOTT
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State | AZ
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Zip | 86303-4626
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Country | US
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Telephone | 928-778-3086
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Fax |
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Provider Business Mailing Address
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Address Line | 6810 E SPOUSE DR APT 173
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-6644
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Country | US
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Telephone | 928-515-3039
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Fax |
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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 | S013994
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302025361
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License Number State | MI
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