Provider Demographics
NPI:1558606566
Name:CRUMP, SPENCER JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:JAMES
Last Name:CRUMP
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 1:5902 W 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1917
Mailing Address - Country:US
Mailing Address - Phone:801-623-9294
Mailing Address - Fax:
Practice Address - Street 1:5902 W 26TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1917
Practice Address - Country:US
Practice Address - Phone:801-623-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60299522183500000X
UT7452115-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist