Provider Demographics
NPI:1386974574
Name:MCCRORY, MARK LESTER (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LESTER
Last Name:MCCRORY
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 1:9115 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8819
Mailing Address - Country:US
Mailing Address - Phone:520-749-0205
Mailing Address - Fax:520-749-9481
Practice Address - Street 1:9115 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-8819
Practice Address - Country:US
Practice Address - Phone:520-749-0205
Practice Address - Fax:520-749-9481
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist