MEDICARE: MR. LONNIE JOE CRAFT 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
1	183500000X	Pharmacist	03-2-21205	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03221205	OTHER	OH	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1093974925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LONNIE JOE CRAFT RPH

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-0126
Country	:	US
Telephone Number	:	614-573-1557
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S JEFFERSON AVE
Second Line	:	STE 200
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4137
Country	:	US
Telephone Number	:	614-873-0880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	02/26/2025

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