Provider Demographics
NPI:1811145121
Name:CROUS, GERHARD IGNATIUS
Entity type:Individual
Prefix:MR
First Name:GERHARD
Middle Name:IGNATIUS
Last Name:CROUS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GERHARD
Other - Middle Name:IGNATIUS
Other - Last Name:CROUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 N SAGINAW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1145
Mailing Address - Country:US
Mailing Address - Phone:817-232-3877
Mailing Address - Fax:
Practice Address - Street 1:1201 N SAGINAW BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1145
Practice Address - Country:US
Practice Address - Phone:817-232-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist