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NPI Code Detail

MEDICARE: MR. KELVIN DOUGLAS CRAFTON RPH

MEDICARE: MR. KELVIN DOUGLAS CRAFTON RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy PharmacistPH10516WA
21835P1200XPharmacotherapy PharmacistP5225ID

General Provider Information

NPI Number : 1023011319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KELVIN DOUGLAS CRAFTON RPH
Provider Business Mailing Address
First Line : 104 S FREYA ST
Second Line : STE 225 TURQUOISE FLAG BLDG
City : SPOKANE
State : WA
Zip : 99202-4862
Country : US
Telephone Number : 509-343-5200
Fax Number : 509-343-5199
Provider Business Practice Location Address
First Line : 104 S FREYA ST
Second Line : STE 225 TURQUOISE FLAG BLDG
City : SPOKANE
State : WA
Zip : 99202-4862
Country : US
Telephone Number : 509-343-5200
Fax Number : 509-343-5199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 11/20/2014

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