Provider Demographics
NPI:1215242714
Name:CROASDALE, GUY EDWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:EDWARD
Last Name:CROASDALE
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 1:46 ALLENSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ALLENSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03275-1809
Mailing Address - Country:US
Mailing Address - Phone:603-485-5935
Mailing Address - Fax:603-268-0742
Practice Address - Street 1:46 ALLENSTOWN RD
Practice Address - Street 2:
Practice Address - City:ALLENSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03275
Practice Address - Country:US
Practice Address - Phone:603-485-5935
Practice Address - Fax:603-268-0742
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist