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General NPI Number Information
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NPI Number | 1851896963
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Entity Type | Individual
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Provider Name | MITCHELL DEGRAZIER CROUCH
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 3737 DACOMA ST
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City | HOUSTON
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State | TX
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Zip | 77092-8905
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Country | US
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Telephone | 713-248-7869
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Fax |
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Provider Business Mailing Address
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Address Line | 137 WHITE DR
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City | BELLAIRE
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State | TX
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Zip | 77401-4204
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Country | US
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Telephone | 214-546-8061
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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 | 66994
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 66994
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License Number State | TX
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