Provider Demographics
NPI:1568690444
Name:CROSS, CAROL A (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
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:CMR 411 BOX 3194
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:0490961-479-1394
Mailing Address - Fax:
Practice Address - Street 1:BLD 169
Practice Address - Street 2:RM 101
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-0000
Practice Address - Country:US
Practice Address - Phone:314-476-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist