Provider Demographics
NPI:1437431483
Name:CRAWLEY, DONALD WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:CRAWLEY
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 1:4741 THORNHILL AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1523
Mailing Address - Country:US
Mailing Address - Phone:318-207-7295
Mailing Address - Fax:
Practice Address - Street 1:3300 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2124
Practice Address - Country:US
Practice Address - Phone:318-742-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist