Provider Demographics
NPI:1184028268
Name:CROWE, STEPHEN GRAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GRAY
Last Name:CROWE
Suffix:
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 1:351 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-4137
Mailing Address - Country:US
Mailing Address - Phone:304-425-9232
Mailing Address - Fax:304-425-9232
Practice Address - Street 1:1229 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2465
Practice Address - Country:US
Practice Address - Phone:304-425-9232
Practice Address - Fax:304-425-9232
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist