Provider Demographics
NPI:1215227079
Name:CRAWFORD, JACLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:320 HIGHWAY 52 BYP W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1739
Mailing Address - Country:US
Mailing Address - Phone:615-666-3613
Mailing Address - Fax:615-666-2684
Practice Address - Street 1:320 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1739
Practice Address - Country:US
Practice Address - Phone:615-666-3613
Practice Address - Fax:615-666-2684
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist