Provider Demographics
NPI:1629141957
Name:M. C. MADDUX - B. A. CROWSON
Entity Type:Organization
Organization Name:M. C. MADDUX - B. A. CROWSON
Other - Org Name:TERRACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROWSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:530-342-0171
Mailing Address - Street 1:1283 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1548
Mailing Address - Country:US
Mailing Address - Phone:530-342-0171
Mailing Address - Fax:530-342-4153
Practice Address - Street 1:1283 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1548
Practice Address - Country:US
Practice Address - Phone:530-342-0171
Practice Address - Fax:530-342-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY305563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0530332OtherNCPDP
CAPHA305560Medicaid
CAPHA305560Medicaid