Provider Demographics
NPI:1376984401
Name:CRUMP, EVAN RIDLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:RIDLEY
Last Name:CRUMP
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 1:4005 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5161
Mailing Address - Country:US
Mailing Address - Phone:307-745-1557
Mailing Address - Fax:307-742-0787
Practice Address - Street 1:4005 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5161
Practice Address - Country:US
Practice Address - Phone:307-745-1557
Practice Address - Fax:307-742-0787
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist