Provider Demographics
NPI:1033133681
Name:CROWDERS INSTITUTIONAL PHARMACY
Entity Type:Organization
Organization Name:CROWDERS INSTITUTIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-329-6466
Mailing Address - Street 1:629 16TH ST
Mailing Address - Street 2:PO BOX 966
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3818
Mailing Address - Country:US
Mailing Address - Phone:812-275-5949
Mailing Address - Fax:812-275-4963
Practice Address - Street 1:629 EAST 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3818
Practice Address - Country:US
Practice Address - Phone:812-275-5949
Practice Address - Fax:812-275-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100175500AMedicaid