Provider Demographics
NPI:1457959959
Name:CROWDER, TERRY J (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:CROWDER
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 1:11800 ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-4605
Mailing Address - Country:US
Mailing Address - Phone:541-971-7080
Mailing Address - Fax:
Practice Address - Street 1:1357 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-1126
Practice Address - Country:US
Practice Address - Phone:503-828-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist