Individual
MR. KENNETH CODY CROUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
1631 A EAST HWY 66, EL RENO, OK 73036
(405) 262-7631
(405) 262-8099
Mailing address
1501 W DEBBIE, ELK CITY, OK 73644-1200
(580) 225-2860
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11888
OK
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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