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General NPI Number Information
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NPI Number | 1679858658
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Entity Type | Individual
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Provider Name | MARLO JOHNSON CROSBY
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Gender | Female
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 1585 SHERIDAN AVE
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City | CODY
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State | WY
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Zip | 82414-3819
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Country | US
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Telephone | 307-587-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 WEST AVE UNIT A
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City | CODY
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State | WY
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Zip | 82414
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Country | US
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Telephone | 218-730-7259
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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 | S016384
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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 | 15418-40
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 116025
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License Number State | MN
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