Provider Demographics
NPI:1669653259
Name:CROWNE, NENA M (RPH)
Entity Type:Individual
Prefix:
First Name:NENA
Middle Name:M
Last Name:CROWNE
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 1:142 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2711
Mailing Address - Country:US
Mailing Address - Phone:315-363-7856
Mailing Address - Fax:315-363-9440
Practice Address - Street 1:142 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2711
Practice Address - Country:US
Practice Address - Phone:315-363-7856
Practice Address - Fax:315-363-9440
Is Sole Proprietor?:No
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045834-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02771479Medicaid