Provider Demographics
NPI:1558810390
Name:CROMER, RUSTY (RPH)
Entity Type:Individual
Prefix:
First Name:RUSTY
Middle Name:
Last Name:CROMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 DOERING DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4211
Mailing Address - Country:US
Mailing Address - Phone:859-282-8833
Mailing Address - Fax:859-282-9459
Practice Address - Street 1:7625 DOERING DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4211
Practice Address - Country:US
Practice Address - Phone:859-282-8833
Practice Address - Fax:859-282-9459
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist