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General NPI Number Information
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NPI Number | 1932471703
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Entity Type | Individual
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Provider Name | MICHAEL CROOKSTON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 2190 W DRAKE RD
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City | FORT COLLINS
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State | CO
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Zip | 80526-1488
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Country | US
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Telephone | 970-484-5841
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Fax | 970-484-6913
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Provider Business Mailing Address
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Address Line | 2724 MICHENER DR
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City | FORT COLLINS
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State | CO
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Zip | 80526-6237
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Country | US
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Telephone |
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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 | PHA.0019701
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License Number State | CO
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