Provider Demographics
NPI:1164892931
Name:CRAWFORD, BRADLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-2310
Mailing Address - Country:US
Mailing Address - Phone:260-463-7464
Mailing Address - Fax:260-463-8150
Practice Address - Street 1:420 S DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-2310
Practice Address - Country:US
Practice Address - Phone:260-463-7464
Practice Address - Fax:260-463-8150
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022452A183500000X
ORRPH-00148261835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist