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NPI Code Detail

MEDICARE: MRS. LYNNE D CRUSOE RPH, CDE

MEDICARE: MRS. LYNNE D CRUSOE RPH, CDE
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
1183500000XPharmacist10205NC
2183500000XPharmacist6152SC

General Provider Information

NPI Number : 1730176132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYNNE D CRUSOE RPH, CDE
Provider Business Mailing Address
First Line : 6241 HILBERT RIDGE DR
Second Line :
City : HOLLY SPRINGS
State : NC
Zip : 27540-8554
Country : US
Telephone Number : 919-470-4168
Fax Number : 919-470-7365
Provider Business Practice Location Address
First Line : 3643 N ROXBORO ST
Second Line :
City : DURHAM
State : NC
Zip : 27704-2702
Country : US
Telephone Number : 919-470-4168
Fax Number : 919-470-7365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 02/19/2016

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