Healthcare Provider Details

I. General information

NPI: 1023011319
Provider Name (Legal Business Name): KELVIN DOUGLAS CRAFTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST STE 225 TURQUOISE FLAG BLDG
SPOKANE WA
99202-4862
US

IV. Provider business mailing address

104 S FREYA ST STE 225 TURQUOISE FLAG BLDG
SPOKANE WA
99202-4862
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-5200
  • Fax: 509-343-5199
Mailing address:
  • Phone: 509-343-5200
  • Fax: 509-343-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH10516
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP5225
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: