Provider Demographics
NPI:1184048381
Name:CROW, NATHAN C (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:C
Last Name:CROW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 N HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-9708
Mailing Address - Country:US
Mailing Address - Phone:928-445-3020
Mailing Address - Fax:928-445-6102
Practice Address - Street 1:3050 N HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-9708
Practice Address - Country:US
Practice Address - Phone:928-445-3020
Practice Address - Fax:928-445-6102
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist