Provider Demographics
NPI:1861749350
Name:CROWE, MATTHEW AUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AUSTIN
Last Name:CROWE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2019 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-6336
Mailing Address - Country:US
Mailing Address - Phone:256-605-7974
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3458
Practice Address - Country:US
Practice Address - Phone:256-997-2124
Practice Address - Fax:256-997-2503
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALP17125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist