Provider Demographics
NPI:1023011319
Name:CRAFTON, KELVIN DOUGLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:DOUGLAS
Last Name:CRAFTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST
Mailing Address - Street 2:STE 225 TURQUOISE FLAG BLDG
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4862
Mailing Address - Country:US
Mailing Address - Phone:509-343-5200
Mailing Address - Fax:509-343-5199
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:STE 225 TURQUOISE FLAG BLDG
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4862
Practice Address - Country:US
Practice Address - Phone:509-343-5200
Practice Address - Fax:509-343-5199
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH105161835P1200X
IDP52251835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy