Provider Demographics
NPI:1881710697
Name:CRUME, RANDY ELMER (RPH)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:ELMER
Last Name:CRUME
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:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-0712
Mailing Address - Country:US
Mailing Address - Phone:503-556-3720
Mailing Address - Fax:503-366-0610
Practice Address - Street 1:785 S COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2928
Practice Address - Country:US
Practice Address - Phone:503-397-6787
Practice Address - Fax:503-366-0610
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0006427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist