Provider Demographics
NPI:1245059690
Name:CROSSLIN, JUSTIN PAUL (CPHT-ADV)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:CROSSLIN
Suffix:
Gender:M
Credentials:CPHT-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 MADISON ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5281
Mailing Address - Country:US
Mailing Address - Phone:931-896-2126
Mailing Address - Fax:
Practice Address - Street 1:1849 MADISON ST STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5281
Practice Address - Country:US
Practice Address - Phone:931-896-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59078183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician