Healthcare Provider Details

I. General information

NPI: 1124179916
Provider Name (Legal Business Name): JOHN ANDREW CRAWFORD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST RM 1411
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

1801 W TAYLOR ST RM 1411
CHICAGO IL
60612-4795
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6985
  • Fax: 312-355-1515
Mailing address:
  • Phone: 312-996-6985
  • Fax: 312-355-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051287274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: