Provider Demographics
NPI:1669684270
Name:CRSM INC
Entity Type:Organization
Organization Name:CRSM INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RALDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:340-776-1235
Mailing Address - Street 1:9004 HAVENSIGHT SHOPPING CENTER
Mailing Address - Street 2:SUITE D-F
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2657
Mailing Address - Country:US
Mailing Address - Phone:340-776-1235
Mailing Address - Fax:340-776-1776
Practice Address - Street 1:9004 HAVENSIGHT SHOPPING CENTER
Practice Address - Street 2:SUITE D-F
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2657
Practice Address - Country:US
Practice Address - Phone:340-776-1235
Practice Address - Fax:340-776-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-11242-1L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1337Medicaid
VI1337Medicaid