Provider Demographics
NPI:1386035806
Name:CROWE, BRODY WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:BRODY
Middle Name:WILLIAM
Last Name:CROWE
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 1:1230 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3304
Mailing Address - Country:US
Mailing Address - Phone:308-384-2626
Mailing Address - Fax:308-384-2983
Practice Address - Street 1:1230 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3304
Practice Address - Country:US
Practice Address - Phone:308-384-2626
Practice Address - Fax:308-384-2983
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist