Provider Demographics
NPI:1215990916
Name:CROSWELL, IRENE (RPH)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CROSWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N PACIFIC HWY
Mailing Address - Street 2:SAFEWAY PHARMACY #1976
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-3622
Mailing Address - Country:US
Mailing Address - Phone:503-982-2864
Mailing Address - Fax:503-982-2868
Practice Address - Street 1:1550 N PACIFIC HWY
Practice Address - Street 2:SAFEWAY PHARMACY #1976
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-3622
Practice Address - Country:US
Practice Address - Phone:503-982-2864
Practice Address - Fax:503-982-2868
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9231183500000X
LA11671183500000X
OROR00092311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist