Provider Demographics
NPI:1336449412
Name:CRISPIN, RANDY LEE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:CRISPIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 WALDORF MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4871
Mailing Address - Country:US
Mailing Address - Phone:301-632-5684
Mailing Address - Fax:301-632-5688
Practice Address - Street 1:3051 WALDORF MARKET PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4871
Practice Address - Country:US
Practice Address - Phone:301-632-5684
Practice Address - Fax:301-632-5688
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist