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NPI Code Detail

MEDICARE: RANDY LEE CRISPIN PHARMACIST

MEDICARE:   RANDY LEE CRISPIN  PHARMACIST
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
1183500000XPharmacist09099MD

General Provider Information

NPI Number : 1336449412
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDY LEE CRISPIN PHARMACIST
Provider Business Mailing Address
First Line : 3051 WALDORF MARKET PL
Second Line :
City : WALDORF
State : MD
Zip : 20603-4871
Country : US
Telephone Number : 301-632-5684
Fax Number : 301-632-5688
Provider Business Practice Location Address
First Line : 3051 WALDORF MARKET PL
Second Line :
City : WALDORF
State : MD
Zip : 20603-4871
Country : US
Telephone Number : 301-632-5684
Fax Number : 301-632-5688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2010
Last Update Date : 10/23/2010

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Directions to “ RANDY LEE CRISPIN PHARMACIST” Practice Location

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