Healthcare Provider Details

I. General information

NPI: 1588905988
Provider Name (Legal Business Name): BROOKE SORGEN CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE DEPARTMENT OF PHARMACY, DOAN 110
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-6862
  • Fax:
Mailing address:
  • Phone: 317-988-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number26021822A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH03127190
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH022813
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: