Individual ProviderMonty Dale CrowdesPharmacistPharmacy Service ProvidersPractice Address101 Bodin Cir, R 2b417, Travis Afb, CA 94535-1809(707) 423-7657PECOS EnrollmentBased on the most recent information from CMS, provider Monty Dale Crowdes does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:10 AM.Profile DetailsProvider ID1235402686Provider TypeIndividualFull NameCrowdes, Monty DaleCredentialRPHGenderMaleSole ProprietorYesEnumeration Date2/15/2012Last Updated2/15/2012Contact InformationPractice LocationPractice Address101 Bodin Cir, R 2b417, Travis Afb, CA 94535-1809Phone(707) 423-7657FaxUnlisted FaxMailing LocationMailing Address101 Bodin Cir, R 2b417, Travis Afb, CA 94535-1809Phone(707) 423-7657FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense17168IowaProvider IdentifiersIDDescriptionIssuerID17168DescriptionOtherIssuerSTATE LICENSEIowa