Healthcare Provider Details

I. General information

NPI: 1689018061
Provider Name (Legal Business Name): EDWIN M CRAWFORD R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RICHMOND AVE ATTN: PHARMACY
STAUNTON VA
24401-9146
US

IV. Provider business mailing address

1301 RICHMOND AVE ATTN: PHARMACY
STAUNTON VA
24401-9146
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-8041
  • Fax: 540-332-8044
Mailing address:
  • Phone: 540-332-8041
  • Fax: 540-332-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0202011723
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: