Provider Demographics
NPI:1538800644
Name:CROWDER, CHANOLA
Entity type:Individual
Prefix:
First Name:CHANOLA
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24850 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1599
Mailing Address - Country:US
Mailing Address - Phone:248-968-2383
Mailing Address - Fax:248-968-2388
Practice Address - Street 1:24850 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1599
Practice Address - Country:US
Practice Address - Phone:248-968-2383
Practice Address - Fax:248-968-2388
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician