Provider Demographics
NPI:1013096304
Name:CRC, INC
Entity type:Organization
Organization Name:CRC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-795-4488
Mailing Address - Street 1:7655 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7904
Mailing Address - Country:US
Mailing Address - Phone:352-795-4488
Mailing Address - Fax:352-795-2588
Practice Address - Street 1:7655 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7904
Practice Address - Country:US
Practice Address - Phone:352-795-4488
Practice Address - Fax:352-795-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH17743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0333550001Medicare NSC