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General NPI Number Information
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NPI Number | 1023177938
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Entity Type | Organization
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Legal Business Name | CRAWFORD PHARMACY OF BANDERA LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 907 N MAIN
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City | BANDERA
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State | TX
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Zip | 78003
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Country | US
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Telephone | 830-460-4205
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Fax | 830-796-4537
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Provider Business Mailing Address
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Address Line | PO BOX 218 907 N MAIN
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City | BANDERA
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State | TX
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Zip | 78003
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Country | US
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Telephone | 830-460-4205
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Fax | 830-796-4537
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Authorized Official
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Title or Position | MEMBER/CFO
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Name | PREM S KALIDINDI
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Credential | RPH
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Telephone | 917-769-8014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 27778
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License Number State | TX
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