Basic Information
| Provider Information | |||||||||
| NPI: | 1811597503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROCKETT | ||||||||
| FirstName: | SCHRELL | ||||||||
| MiddleName: | LAPRI | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1408 HOLLY | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723421930 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 SHEILA DR | ||||||||
| Address2: | |||||||||
| City: | WEST HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723901823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705726741 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD14622 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.