Provider Demographics
NPI:1598204547
Name:CRAWFORDVILLE PHARMACY INC
Entity Type:Organization
Organization Name:CRAWFORDVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-874-9878
Mailing Address - Street 1:2650 CRAWFORDVILLE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2369
Mailing Address - Country:US
Mailing Address - Phone:352-874-9878
Mailing Address - Fax:
Practice Address - Street 1:2650 CRAWFORDVILLE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327
Practice Address - Country:US
Practice Address - Phone:352-874-9878
Practice Address - Fax:352-874-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH306473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168095OtherPK