Provider Demographics
NPI:1629457429
Name:CROWSON, BRUCE (CPHT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:CROWSON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COHASSET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2235
Mailing Address - Country:US
Mailing Address - Phone:530-343-4440
Mailing Address - Fax:530-343-4449
Practice Address - Street 1:251 COHASSET RD STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2235
Practice Address - Country:US
Practice Address - Phone:530-343-4440
Practice Address - Fax:530-343-4449
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician