Provider Demographics
NPI:1649551144
Name:CRITCHLOW, MARK G (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:CRITCHLOW
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 1:3463 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8609
Mailing Address - Country:US
Mailing Address - Phone:360-733-1980
Mailing Address - Fax:360-738-4628
Practice Address - Street 1:1400 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4520
Practice Address - Country:US
Practice Address - Phone:360-733-1980
Practice Address - Fax:360-738-4628
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00017105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist