Provider Demographics
NPI:1487839643
Name:CRIMMINS, DAVID MICHAEL
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:CRIMMINS
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 1:47 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PALENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12463-2203
Mailing Address - Country:US
Mailing Address - Phone:518-678-5611
Mailing Address - Fax:
Practice Address - Street 1:47 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:PALENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12463-2203
Practice Address - Country:US
Practice Address - Phone:518-678-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist