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General NPI Number Information
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NPI Number | 1407106388
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Entity Type | Individual
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Provider Name | JOHN LEWIS CRENSHAW RPH
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Gender | Male
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 7425 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6749
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Country | US
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Telephone | 317-359-6389
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Fax | 317-357-2930
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Provider Business Mailing Address
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Address Line | 7425 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6749
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Country | US
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Telephone | 317-359-6389
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Fax | 317-357-2930
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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 | 26013754A
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License Number State | IN
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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 | 2004014243
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License Number State | MO
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