Provider Demographics
NPI:1245595958
Name:CROWLEY GETTYS, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:CROWLEY GETTYS, A PROFESSIONAL CORP.
Other - Org Name:PATHWAY SPEACIALTY COMPOUNDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:MECEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-541-6023
Mailing Address - Street 1:2560 E SUNSET RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3517
Mailing Address - Country:US
Mailing Address - Phone:702-541-6023
Mailing Address - Fax:
Practice Address - Street 1:2560 E SUNSET RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3517
Practice Address - Country:US
Practice Address - Phone:702-541-6023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH02590333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy