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General NPI Number Information
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NPI Number | 1770586141
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Entity Type | Organization
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Legal Business Name | CROWDERS NEIGHBORHOOD DRUG STORE INC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 631 16TH ST
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City | BEDFORD
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State | IN
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Zip | 47421-3818
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Country | US
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Telephone | 812-275-5949
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Fax | 812-277-3631
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | BEDFORD
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State | IN
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Zip | 47421-0966
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Country | US
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Telephone | 812-275-5959
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Fax | 812-277-3632
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Authorized Official
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Title or Position | R.PH/OWNER
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Name | STEVEN ANDERSON
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Credential | B.S.
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Telephone | 812-275-5949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60000019A
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License Number State | IN
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