=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437852001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFFREY A CRABTREE CERTIFIED PHARMACY T
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2023
-----------------------------------------------------
Last Update Date | 03/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3653 VIRGINIA BEACH BLVD
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-463-2811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3636 MALIBU PALMS DR APT 203
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-819-3941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 0230010397
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------