Provider Demographics
NPI:1699145656
Name:CRUMMEDYO, TARSHA
Entity type:Individual
Prefix:
First Name:TARSHA
Middle Name:
Last Name:CRUMMEDYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 CHURCHLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1694
Mailing Address - Country:US
Mailing Address - Phone:713-398-1949
Mailing Address - Fax:
Practice Address - Street 1:9403 CHURCHLAKE CIR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1694
Practice Address - Country:US
Practice Address - Phone:713-398-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist