Healthcare Provider Details

I. General information

NPI: 1992879415
Provider Name (Legal Business Name): CRAWFORD PROFESSIONAL DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S 13TH AVE
LAUREL MS
39440-4226
US

IV. Provider business mailing address

240 S 13TH AVE
LAUREL MS
39440-4226
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-2527
  • Fax: 601-425-2528
Mailing address:
  • Phone: 601-425-2527
  • Fax: 601-425-2528

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 Number01098011
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRY CRAWFORD
Title or Position: OWNER, PRES, PIC,AO
Credential: REG. PHARM
Phone: 601-425-2527