Provider Demographics
NPI:1598109860
Name:CROOKS, JANET LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LOUISE
Last Name:CROOKS
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 1:894 GEORGE ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2601
Mailing Address - Country:US
Mailing Address - Phone:971-719-5801
Mailing Address - Fax:503-581-8206
Practice Address - Street 1:5285 MEADOWS RD STE 320
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3478
Practice Address - Country:US
Practice Address - Phone:503-785-9936
Practice Address - Fax:610-335-4001
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00069081835P0018X
ORRPH0006908183500000X
OR183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500761210Medicaid