Provider Demographics
NPI:1386160422
Name:CROUCH, JEFFRY DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:DAVID
Last Name:CROUCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11703 E SPRAGUE AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6129
Mailing Address - Country:US
Mailing Address - Phone:509-921-6560
Mailing Address - Fax:
Practice Address - Street 1:11703 E SPRAGUE AVE STE C3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6129
Practice Address - Country:US
Practice Address - Phone:509-921-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60754742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist