Provider Demographics
NPI:1477208767
Name:CRAPO, NATHAN
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:CRAPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 E OLLA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1577
Mailing Address - Country:US
Mailing Address - Phone:480-369-2386
Mailing Address - Fax:
Practice Address - Street 1:925 E COVEY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5674
Practice Address - Country:US
Practice Address - Phone:623-815-8965
Practice Address - Fax:623-815-1222
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0223881835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric