Provider Demographics
NPI:1730176132
Name:CRUSOE, LYNNE D (RPH, CDE)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:D
Last Name:CRUSOE
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 HILBERT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8554
Mailing Address - Country:US
Mailing Address - Phone:919-470-4168
Mailing Address - Fax:919-470-7365
Practice Address - Street 1:3643 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2702
Practice Address - Country:US
Practice Address - Phone:919-470-4168
Practice Address - Fax:919-470-7365
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10205183500000X
SC6152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist