Provider Demographics
NPI:1164631206
Name:CRABTREE, HERMAN DALE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:DALE
Last Name:CRABTREE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 LAKE KATHERINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9257
Mailing Address - Country:US
Mailing Address - Phone:740-288-0714
Mailing Address - Fax:
Practice Address - Street 1:500 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9360
Practice Address - Country:US
Practice Address - Phone:740-395-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122747183500000X
OH03-1-22747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist