Provider Demographics
NPI:1588087118
Name:CRUTCHER, MEREDEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MEREDEE
Middle Name:
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4150
Mailing Address - Country:US
Mailing Address - Phone:415-721-3562
Mailing Address - Fax:415-721-3563
Practice Address - Street 1:4040 CIVIC CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4150
Practice Address - Country:US
Practice Address - Phone:415-721-3562
Practice Address - Fax:415-721-3563
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388061835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPL38806OtherPHARMACY LICENSE