Provider Demographics
NPI:1083216667
Name:MCCROSSEN, DEAN ROBERT
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:ROBERT
Last Name:MCCROSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2924
Mailing Address - Country:US
Mailing Address - Phone:248-930-3716
Mailing Address - Fax:
Practice Address - Street 1:2500 S ADAMS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-5518
Practice Address - Country:US
Practice Address - Phone:248-853-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315108294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist