Healthcare Provider Details

I. General information

NPI: 1770586141
Provider Name (Legal Business Name): CROWDERS NEIGHBORHOOD DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 16TH ST
BEDFORD IN
47421-3818
US

IV. Provider business mailing address

PO BOX 966
BEDFORD IN
47421-0966
US

V. Phone/Fax

Practice location:
  • Phone: 812-275-5949
  • Fax: 812-277-3631
Mailing address:
  • Phone: 812-275-5959
  • Fax: 812-277-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60000019A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ANDERSON
Title or Position: R.PH/OWNER
Credential: B.S.
Phone: 812-275-5949