Provider Demographics
NPI:1336787308
Name:CROWELL, VERNON DEWAYNE JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:DEWAYNE
Last Name:CROWELL
Suffix:JR
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 1:220 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2057
Mailing Address - Country:US
Mailing Address - Phone:870-946-4221
Mailing Address - Fax:
Practice Address - Street 1:220 COURT SQ
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2057
Practice Address - Country:US
Practice Address - Phone:870-946-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC15041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist