Provider Demographics
NPI:1528423282
Name:CROW, GERALD EDWARD
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:EDWARD
Last Name:CROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-3448
Mailing Address - Country:US
Mailing Address - Phone:830-534-7395
Mailing Address - Fax:
Practice Address - Street 1:925 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-1851
Practice Address - Country:US
Practice Address - Phone:830-393-8098
Practice Address - Fax:830-393-8144
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX56969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX56969OtherTEXAS PHARMACY LISCENSE