Provider Demographics
NPI:1326348806
Name:CRUMLEY, SUZETTE BALWING (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:BALWING
Last Name:CRUMLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:
Other - Last Name:BALWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7788 REGENTS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-455-6340
Mailing Address - Fax:858-455-1764
Practice Address - Street 1:7788 REGENTS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122
Practice Address - Country:US
Practice Address - Phone:858-455-6340
Practice Address - Fax:858-455-1764
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16966183500000X
CACA59203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist