Provider Demographics
NPI:1609488717
Name:CRISWELL, ANDREW RENFRO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RENFRO
Last Name:CRISWELL
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 1:3251 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4947
Mailing Address - Country:US
Mailing Address - Phone:479-756-1290
Mailing Address - Fax:479-756-1455
Practice Address - Street 1:3251 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4947
Practice Address - Country:US
Practice Address - Phone:479-756-1290
Practice Address - Fax:479-756-1455
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist