Provider Demographics
NPI:1689888539
Name:CROFT, ALBERT CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:CHARLES
Last Name:CROFT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 AVALON DR SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2155
Mailing Address - Country:US
Mailing Address - Phone:330-856-9667
Mailing Address - Fax:330-856-9557
Practice Address - Street 1:475 AVALON DR SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2155
Practice Address - Country:US
Practice Address - Phone:330-856-9667
Practice Address - Fax:330-856-9557
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-11305183500000X
FLPS31217183500000X
PARP-041131-R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist