PATRICK K CROSBY
18638 Main St
Groveland, CA 95321
209-962-5211
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 332B00000X | Suppliers - Durable Medical Equipment & Medical Supplies - | CA | 4743490001 |
Y | 3336C0003X | Suppliers - Pharmacy | CA | PHY39864 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
NCPDP PROVIDER IDENTIFICATION NUMBER | 0586416 | OTHER | |
PTAN FOR MASS IMMUNIZATION ROSTER BILLER | GM613A | CA | OTHER |