MEDICARE: RANDY ELMER CRUME RPH

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	0006427	OR

General Provider Information

NPI Number	:	1881710697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY ELMER CRUME RPH

Provider Business Mailing Address
First Line	:	PO BOX 712
Second Line	:
City	:	RAINIER
State	:	OR
Zip	:	97048-0712
Country	:	US
Telephone Number	:	503-556-3720
Fax Number	:	503-366-0610

Provider Business Practice Location Address
First Line	:	785 S COLUMBIA RIVER HWY
Second Line	:
City	:	SAINT HELENS
State	:	OR
Zip	:	97051-2928
Country	:	US
Telephone Number	:	503-397-6787
Fax Number	:	503-366-0610

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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