Provider Demographics
NPI:1538409438
Name:CRUMP, CLINTON DAN (RPH)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:DAN
Last Name:CRUMP
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 1:3804 E HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7606
Mailing Address - Country:US
Mailing Address - Phone:817-579-2512
Mailing Address - Fax:817-579-2516
Practice Address - Street 1:3804 E HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7606
Practice Address - Country:US
Practice Address - Phone:817-579-2512
Practice Address - Fax:817-579-2516
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist