Individual
MR. CROCKETT TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4205 98TH ST, LUBBOCK, TX 79423-3971
(806) 798-6115
(806) 798-6117
Mailing address
4205 98TH ST, LUBBOCK, TX 79423-3971
(806) 798-6115
(806) 798-6117
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
38448
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38448
PHARMACY LICENSE
TX
Enumeration date
09/24/2014
Last updated
09/24/2014
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