Provider Demographics
NPI:1669663134
Name:CRAWFORD PHARMACY, LLC
Entity Type:Organization
Organization Name:CRAWFORD PHARMACY, LLC
Other - Org Name:CRAWFORD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RP IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:308-665-1395
Mailing Address - Street 1:312 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:NE
Mailing Address - Zip Code:69339-1052
Mailing Address - Country:US
Mailing Address - Phone:308-665-1395
Mailing Address - Fax:
Practice Address - Street 1:312 2ND ST
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:NE
Practice Address - Zip Code:69339-1052
Practice Address - Country:US
Practice Address - Phone:308-665-1395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE309332B00000X, 3336C0002X, 3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6039740001Medicare NSC