Healthcare Provider Details

I. General information

NPI: 1114302106
Provider Name (Legal Business Name): CAMBRIA CRAWFORD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W NORTHLAND AVE
APPLETON WI
54914-1426
US

IV. Provider business mailing address

729 W NORTHLAND AVE
APPLETON WI
54914-1426
US

V. Phone/Fax

Practice location:
  • Phone: 920-954-8100
  • Fax:
Mailing address:
  • Phone: 920-954-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22538-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: