Provider Demographics
NPI:1699958413
Name:CROUCH, KAREN C (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:CROUCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1572
Mailing Address - Country:US
Mailing Address - Phone:315-597-1733
Mailing Address - Fax:315-598-1748
Practice Address - Street 1:1818 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1572
Practice Address - Country:US
Practice Address - Phone:315-598-1733
Practice Address - Fax:315-598-1748
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist