Provider Demographics
NPI:1942303557
Name:CROWE, ERNEST WESLEY (RPH)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:WESLEY
Last Name:CROWE
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:RTE 1 BOX 221-B
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457
Mailing Address - Country:US
Mailing Address - Phone:912-529-3956
Mailing Address - Fax:912-529-6197
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:SOPERTON PHARMACY INC
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457
Practice Address - Country:US
Practice Address - Phone:912-529-3234
Practice Address - Fax:912-529-6197
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH009726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist