MEDICARE: KIM CROWDER DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6296	TN

General Provider Information

NPI Number	:	1114226511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM CROWDER DPH

Provider Business Mailing Address
First Line	:	4560 HARDING RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-6101
Country	:	US
Telephone Number	:	615-297-2279
Fax Number	:	615-292-9668

Provider Business Practice Location Address
First Line	:	4560 HARDING RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-6101
Country	:	US
Telephone Number	:	615-297-2279
Fax Number	:	615-292-9668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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Directions to “ KIM CROWDER DPH” Practice Location

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