Provider Demographics
NPI:1053691006
Name:CROUCH, LORA KRISHNA (RPH)
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:KRISHNA
Last Name:CROUCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:LORA
Other - Middle Name:KRISHNA
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:522 HALLMAN DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7839
Mailing Address - Country:US
Mailing Address - Phone:803-448-6006
Mailing Address - Fax:
Practice Address - Street 1:1401 ALBRIGHT RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-6576
Practice Address - Country:US
Practice Address - Phone:803-366-3784
Practice Address - Fax:803-366-7455
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist