Provider Demographics
NPI:1437852001
Name:CRABTREE, JEFFFREY A (CERTIFIED PHARMACY T)
Entity Type:Individual
Prefix:
First Name:JEFFFREY
Middle Name:A
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:CERTIFIED PHARMACY T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 MALIBU PALMS DR APT 203
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3666
Mailing Address - Country:US
Mailing Address - Phone:757-819-3941
Mailing Address - Fax:
Practice Address - Street 1:3653 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3418
Practice Address - Country:US
Practice Address - Phone:757-463-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230010397183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician