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General NPI Number Information
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NPI Number | 1669663134
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Entity Type | Organization
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Legal Business Name | CRAWFORD PHARMACY, LLC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 312 2ND ST
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City | CRAWFORD
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State | NE
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Zip | 69339-1052
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Country | US
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Telephone | 308-665-1395
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Fax |
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Provider Business Mailing Address
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Address Line | 312 2ND ST
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City | CRAWFORD
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State | NE
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Zip | 69339-1052
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Country | US
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Telephone | 308-665-1395
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Fax |
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Authorized Official
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Title or Position | OWNER/RP IN CHARGE
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Name | BROOKE MICHELLE HEINE
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Credential | PHARM.D.
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Telephone | 308-665-1395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 309
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 309
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 309
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 309
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License Number State | NE
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 309
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License Number State | NE
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