Provider Demographics
NPI:1407633506
Name:CRUTCHER, MADISON KIMIKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KIMIKO
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 CASE AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5790
Mailing Address - Country:US
Mailing Address - Phone:425-466-3270
Mailing Address - Fax:
Practice Address - Street 1:5525 CASE AVE APT 409
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-5790
Practice Address - Country:US
Practice Address - Phone:425-466-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist