Provider Demographics
NPI:1477834208
Name:CROSKEY, MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CROSKEY
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 1:2270 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3669
Mailing Address - Country:US
Mailing Address - Phone:912-459-0880
Mailing Address - Fax:912-459-0886
Practice Address - Street 1:2270 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3669
Practice Address - Country:US
Practice Address - Phone:912-459-0880
Practice Address - Fax:912-459-0886
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist