Provider Demographics
NPI:1205068756
Name:CROWLEY, LAWRENCE WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:CROWLEY
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 1:114 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1659
Mailing Address - Country:US
Mailing Address - Phone:608-935-5189
Mailing Address - Fax:608-935-2661
Practice Address - Street 1:206 N IOWA ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1548
Practice Address - Country:US
Practice Address - Phone:608-935-3661
Practice Address - Fax:608-935-2661
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11568-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist