Provider Demographics
NPI:1215138938
Name:LANGSTON-CRUSOE, PATRICIA W (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:W
Last Name:LANGSTON-CRUSOE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 NW 55TH WAY
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3032
Mailing Address - Country:US
Mailing Address - Phone:954-760-9607
Mailing Address - Fax:
Practice Address - Street 1:2409 NW 55TH WAY
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-3032
Practice Address - Country:US
Practice Address - Phone:954-760-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23015183500000X
FLPU3663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist