Provider Demographics
NPI:1184032609
Name:CROW, CHARLES MAXWELL (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MAXWELL
Last Name:CROW
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1203
Mailing Address - Country:US
Mailing Address - Phone:440-746-1015
Mailing Address - Fax:
Practice Address - Street 1:8003 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1203
Practice Address - Country:US
Practice Address - Phone:440-746-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist