Healthcare Provider Details

I. General information

NPI: 1669339479
Provider Name (Legal Business Name): JOSEPH CRAHAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S ACCESS RD STE 100
RICE LAKE WI
54868-8558
US

IV. Provider business mailing address

320 S ACCESS RD STE 100
RICE LAKE WI
54868-8558
US

V. Phone/Fax

Practice location:
  • Phone: 715-236-3355
  • Fax:
Mailing address:
  • Phone: 715-236-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2661672
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: