Healthcare Provider Details

I. General information

NPI: 1922583749
Provider Name (Legal Business Name): BREANNE CRAWFORD PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S CANAL ST
CARLSBAD NM
88220-6523
US

IV. Provider business mailing address

2401 S CANAL ST
CARLSBAD NM
88220-6523
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-1029
  • Fax:
Mailing address:
  • Phone: 575-885-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62716
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008938
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: