Provider Demographics
NPI:1548530231
Name:CROCKER, MARY CATHERINE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY CATHERINE
Middle Name:M
Last Name:CROCKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 S MCKENZIE ST.
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-971-6258
Mailing Address - Fax:251-971-6259
Practice Address - Street 1:698 S MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3541
Practice Address - Country:US
Practice Address - Phone:251-971-6258
Practice Address - Fax:251-971-6259
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6495538OtherDRIVERS LISCENSE