Healthcare Provider Details

I. General information

NPI: 1063736452
Provider Name (Legal Business Name): STEVEN LOYD CRAIN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E KEARNEY
SPRINGFIELD MO
65803-4608
US

IV. Provider business mailing address

1000 E PRIMROSE ST
SPRINGFIELD MO
65807-5154
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-7750
  • Fax: 417-862-8029
Mailing address:
  • Phone: 417-269-5584
  • Fax: 417-268-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040330
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: