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General NPI Number Information
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NPI Number | 1619586484
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Entity Type | Individual
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Provider Name | JENNIFER MAURINE CRUMBAUGH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 1208 SALEM RD
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City | BENTON
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State | AR
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Zip | 72019
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Country | US
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Telephone | 501-316-1600
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Fax | 501-316-1700
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Provider Business Mailing Address
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Address Line | 108 RYKER LANE
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City | BENTON
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State | AR
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Zip | 72019
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Country | US
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Telephone | 501-860-1740
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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 | 48947
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License Number State | TX
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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 | PD11421
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License Number State | AR
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