Provider Demographics
NPI:1144388166
Name:CROWE, MARLISE BLANKS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARLISE
Middle Name:BLANKS
Last Name:CROWE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558
Mailing Address - Country:US
Mailing Address - Phone:434-575-0511
Mailing Address - Fax:434-575-1366
Practice Address - Street 1:4121 HALIFAX ROAD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558
Practice Address - Country:US
Practice Address - Phone:434-575-0511
Practice Address - Fax:434-575-1366
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist