Provider Demographics
NPI:1912295155
Name:CROUCH, WILLIAM E JR (CPHT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:CROUCH
Suffix:JR
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024-1031
Mailing Address - Country:US
Mailing Address - Phone:501-257-6335
Mailing Address - Fax:501-257-5012
Practice Address - Street 1:4300 WEST 7TH STREET
Practice Address - Street 2:VA MEDICAL CENTER ( PHARMACY 119/LR )
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-6335
Practice Address - Fax:501-257-5012
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR360101060765236183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician