Provider Demographics
NPI:1356662985
Name:CRANWILL, ROGER THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:THOMAS
Last Name:CRANWILL
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 1:1670 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-5240
Mailing Address - Country:US
Mailing Address - Phone:760-788-7074
Mailing Address - Fax:760-788-2008
Practice Address - Street 1:1670 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-5240
Practice Address - Country:US
Practice Address - Phone:760-788-7074
Practice Address - Fax:760-788-2008
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist