Provider Demographics
NPI:1558661454
Name:CRUSE, DAVID J JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CRUSE
Suffix:JR
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 1:1615 CAMP JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2539
Mailing Address - Country:US
Mailing Address - Phone:618-332-0676
Mailing Address - Fax:618-332-0677
Practice Address - Street 1:1615 CAMP JACKSON RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206
Practice Address - Country:US
Practice Address - Phone:618-332-0676
Practice Address - Fax:618-332-0677
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015021181183500000X
IL051292705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist