Provider Demographics
NPI:1144579020
Name:CRUSENBERRY, RICHARD JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CRUSENBERRY
Suffix:JR
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 1:1185 W MOUNTAIN VIEW RD
Mailing Address - Street 2:APT 2122
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2523
Mailing Address - Country:US
Mailing Address - Phone:423-915-6977
Mailing Address - Fax:
Practice Address - Street 1:1714 HIGHWAY 93
Practice Address - Street 2:SUITE 11
Practice Address - City:FALL BRANCH
Practice Address - State:TN
Practice Address - Zip Code:37656-1763
Practice Address - Country:US
Practice Address - Phone:423-348-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist