Provider Demographics
NPI:1255542346
Name:CROLL, DAVID DIXON
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DIXON
Last Name:CROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4372
Mailing Address - Country:US
Mailing Address - Phone:970-903-3564
Mailing Address - Fax:
Practice Address - Street 1:28 TOWN PLZ
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5102
Practice Address - Country:US
Practice Address - Phone:970-247-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist