MEDICARE: KRISSA J CRAWFORD PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26018446A	IN
2	183500000X	Pharmacist	26018446A	IN
3	1835P1200X	Pharmacotherapy Pharmacist	26018446A	IN

General Provider Information

NPI Number	:	1740238138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISSA J CRAWFORD PHARMD

Provider Business Mailing Address
First Line	:	4700 LAS VEGAS BLVD N
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89191-6600
Country	:	US
Telephone Number	:	702-653-3211
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 E CENTER ST
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3719
Country	:	US
Telephone Number	:	574-269-6674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/27/2020

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