Provider Demographics
NPI:1982681714
Name:CROSSLAND, C. SUSAN (RPH, CACP)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:SUSAN
Last Name:CROSSLAND
Suffix:
Gender:F
Credentials:RPH, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9859 MIAMI BEACH RD NW
Mailing Address - Street 2:
Mailing Address - City:SEABECK
Mailing Address - State:WA
Mailing Address - Zip Code:98380-9707
Mailing Address - Country:US
Mailing Address - Phone:360-830-4677
Mailing Address - Fax:
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:SUITE A 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-459-6736
Practice Address - Fax:253-459-6238
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000096871835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy