Provider Demographics
NPI:1356628267
Name:CROSBY, JOHN W (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:CROSBY
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 1:8100 W COUNTY ROAD 42
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2193
Mailing Address - Country:US
Mailing Address - Phone:952-226-1283
Mailing Address - Fax:952-226-1289
Practice Address - Street 1:8100 W COUNTY ROAD 42
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2193
Practice Address - Country:US
Practice Address - Phone:952-226-1283
Practice Address - Fax:952-226-1289
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist