Healthcare Provider Details

I. General information

NPI: 1003740291
Provider Name (Legal Business Name): MELISSA RENEE CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 OAK RIDGE TPKE
OAK RIDGE TN
37830-6442
US

IV. Provider business mailing address

808 POP HOLLOW RD
CLINTON TN
37716-2009
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-2889
  • Fax:
Mailing address:
  • Phone: 865-483-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44414
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: