Doctor Name: | MR. CROCKETT TIDWELL |
NPI Number: | 1013319714 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RPH |
License Number: | 38448 |
Business Practice Address: | 4205 98th St Lubbock, TX - 794233971 |
Business Phone Number: | 8067986115 |
Business Fax Number: | 8067986117 |
Mailing Address: | 4205 98th St, LUBBOCK |
State: | TX |
Postal Code: | 794233971 |
Phone Number: | 8067986115 |
Fax Number: | 8067986117 |
NPI Enumeration Date: | 09/24/2014 |
NPI Last Update Date: | 09/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1835P0018X |
License Number: | 38448 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Pharmacy Service Providers |
Taxonomy Classification: | Pharmacist |
Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |