Provider Demographics
NPI:1770779555
Name:CROSBY, GARY NEIL (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:NEIL
Last Name:CROSBY
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 1:1428 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4119
Mailing Address - Country:US
Mailing Address - Phone:515-955-5430
Mailing Address - Fax:515-955-1453
Practice Address - Street 1:1428 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4119
Practice Address - Country:US
Practice Address - Phone:515-955-5430
Practice Address - Fax:515-955-1453
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA144991835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy