1992152649 NPI number — DR. BRITTNEY RICHELLE CRUSE PHARMD

Table of content: DR. BRITTNEY RICHELLE CRUSE PHARMD (NPI 1992152649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992152649 NPI number — DR. BRITTNEY RICHELLE CRUSE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUSE
Provider First Name:
BRITTNEY
Provider Middle Name:
RICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUSSELL
Provider Other First Name:
BRITTNEY
Provider Other Middle Name:
RICHELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992152649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GANADO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77962-0315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-771-3590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 WEST YORK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GANADO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-771-3590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2016

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:  57061 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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