Provider Demographics
NPI:1225337645
Name:CRUTCHER, JOHNNIE P (RPH)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:P
Last Name:CRUTCHER
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 1:4120 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8029
Mailing Address - Country:US
Mailing Address - Phone:615-773-8704
Mailing Address - Fax:615-773-8704
Practice Address - Street 1:4120 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8029
Practice Address - Country:US
Practice Address - Phone:615-773-8704
Practice Address - Fax:615-773-8704
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist