1003198847 NPI number — CHRISTINA LYNN CRUMP

Table of content: CHRISTINA LYNN CRUMP (NPI 1003198847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003198847 NPI number — CHRISTINA LYNN CRUMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUMP
Provider First Name:
CHRISTINA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003198847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 FOXTAIL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-623-7611
Provider Business Mailing Address Fax Number:
636-949-6945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 FOXTAIL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63303-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-623-7611
Provider Business Practice Location Address Fax Number:
636-949-6945
Provider Enumeration Date:
09/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  043397 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043397 . This is a "BOARD OF PHARMACY LISCENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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