Provider Demographics
NPI:1093903247
Name:CROWLEY, DEBORA JO (BS)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:JO
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 JENKS HWY
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8039
Mailing Address - Country:US
Mailing Address - Phone:517-645-7680
Mailing Address - Fax:517-645-7698
Practice Address - Street 1:123 E LANSING RD
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-9799
Practice Address - Country:US
Practice Address - Phone:517-645-7680
Practice Address - Fax:517-645-7698
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist