Provider Demographics
NPI:1831365444
Name:CROWLEY, KENTON LANCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENTON
Middle Name:LANCE
Last Name:CROWLEY
Suffix:
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 1:40970 ALTON CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6948
Mailing Address - Country:US
Mailing Address - Phone:626-646-3227
Mailing Address - Fax:
Practice Address - Street 1:8785 W WARM SPRINGS RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1823
Practice Address - Country:US
Practice Address - Phone:702-731-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-03
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15858183500000X, 1835N1003X, 1835P1200X
CA38214183500000X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy