Provider Demographics
NPI:1255321188
Name:CROFT, CAROLYN ANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANNE
Last Name:CROFT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1923
Mailing Address - Country:US
Mailing Address - Phone:316-684-0118
Mailing Address - Fax:316-684-3640
Practice Address - Street 1:6420 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1923
Practice Address - Country:US
Practice Address - Phone:316-684-0118
Practice Address - Fax:316-684-3640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist