Provider Demographics
NPI:1598046732
Name:CRECELIUS, CARYN LEIGH (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:LEIGH
Last Name:CRECELIUS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 E RHODES ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-4334
Mailing Address - Country:US
Mailing Address - Phone:480-586-4976
Mailing Address - Fax:
Practice Address - Street 1:8350 S RIVER PKWY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2615
Practice Address - Country:US
Practice Address - Phone:480-752-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI008419390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program