Provider Demographics
NPI:1326868555
Name:CREW, DECEMBER T (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DECEMBER
Middle Name:T
Last Name:CREW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DECEMBER
Other - Middle Name:T
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12037 E BONITA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-6695
Mailing Address - Country:US
Mailing Address - Phone:216-338-0067
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-123450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist