Provider Demographics
NPI:1710287040
Name:CRAWFORD, COLLIN TED
Entity Type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:TED
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5208
Mailing Address - Country:US
Mailing Address - Phone:925-945-3440
Mailing Address - Fax:925-945-3645
Practice Address - Street 1:600 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5208
Practice Address - Country:US
Practice Address - Phone:925-945-3440
Practice Address - Fax:925-945-3645
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist