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General NPI Number Information
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NPI Number | 1053656835
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Entity Type | Individual
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Provider Name | MICHAEL ELLIS CRAYCRAFT R.PH.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 792 WOODLYN DR S
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City | CINCINNATI
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State | OH
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Zip | 45230-4323
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Country | US
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Telephone | 561-703-1788
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Fax |
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Provider Business Mailing Address
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Address Line | 792 WOODLYN DR S
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City | CINCINNATI
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State | OH
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Zip | 45230-4323
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Country | US
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Telephone | 561-703-1788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03221310
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS 33409
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License Number State | FL
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