Provider Demographics
NPI:1396087383
Name:CRABTREE, VALERIE (RPH)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:SURPRENANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3408
Mailing Address - Country:US
Mailing Address - Phone:309-255-0641
Mailing Address - Fax:
Practice Address - Street 1:1300 E REBECCA LN
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3408
Practice Address - Country:US
Practice Address - Phone:309-255-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL059.041137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist