Provider Demographics
NPI:1508140799
Name:CROSS, CATHERINE MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARY
Last Name:CROSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8364 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8957
Mailing Address - Country:US
Mailing Address - Phone:616-878-0497
Mailing Address - Fax:616-878-0573
Practice Address - Street 1:8364 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8957
Practice Address - Country:US
Practice Address - Phone:616-878-0497
Practice Address - Fax:616-878-0573
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist