Provider Demographics
NPI:1588954184
Name:CROCO, WILLIAM R (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:CROCO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 SE SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3208
Mailing Address - Country:US
Mailing Address - Phone:541-231-8754
Mailing Address - Fax:
Practice Address - Street 1:4500 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3918
Practice Address - Country:US
Practice Address - Phone:503-588-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist