Provider Demographics
NPI:1346909926
Name:CREWS, JERROD AUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERROD
Middle Name:AUSTIN
Last Name:CREWS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112
Mailing Address - Country:US
Mailing Address - Phone:386-698-4922
Mailing Address - Fax:
Practice Address - Street 1:1115 SUMMIT STREET
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112
Practice Address - Country:US
Practice Address - Phone:386-698-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist