MEDICARE: SUE CRANE 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03318508	OH

General Provider Information

NPI Number	:	1144829243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE CRANE RPH

Provider Business Mailing Address
First Line	:	6950 MIAMI AVE
Second Line	:
City	:	MADEIRA
State	:	OH
Zip	:	45243-2633
Country	:	US
Telephone Number	:	513-271-1360
Fax Number	:	513-271-4021

Provider Business Practice Location Address
First Line	:	6950 MIAMI AVE
Second Line	:
City	:	MADEIRA
State	:	OH
Zip	:	45243-2633
Country	:	US
Telephone Number	:	513-271-1360
Fax Number	:	513-271-4021

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

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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Directions to “ SUE CRANE RPH” Practice Location

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