Provider Demographics
NPI:1659462489
Name:CROWELL DRUG CO INC
Entity Type:Organization
Organization Name:CROWELL DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-0750
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1775
Mailing Address - Country:US
Mailing Address - Phone:620-231-0750
Mailing Address - Fax:
Practice Address - Street 1:401 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3913
Practice Address - Country:US
Practice Address - Phone:620-231-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS204635332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1701071OtherNABP
KS100434450AMedicaid
KS100434460AOtherKS MEDICAID DME
KS100434460AOtherKS MEDICAID DME
KS100434450AMedicaid