Provider Demographics
NPI:1043399520
Name:CROUCH, WESLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:CROUCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W 100 S
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1332
Mailing Address - Country:US
Mailing Address - Phone:435-813-2404
Mailing Address - Fax:
Practice Address - Street 1:777 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1165
Practice Address - Country:US
Practice Address - Phone:435-283-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5260544-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist