Provider Demographics
NPI:1578731675
Name:CROWE, JOHN EDWARD JR (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:CROWE
Suffix:JR
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 1:503 SPRINGER CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-4425
Mailing Address - Country:US
Mailing Address - Phone:912-489-2311
Mailing Address - Fax:
Practice Address - Street 1:503 SPRINGER CT
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461-4425
Practice Address - Country:US
Practice Address - Phone:912-489-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA015713OtherLICENSE