Provider Demographics
NPI:1891901567
Name:CRAWFORD, KENNETH EARL III (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EARL
Last Name:CRAWFORD
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4352
Mailing Address - Country:US
Mailing Address - Phone:601-425-2527
Mailing Address - Fax:601-425-2528
Practice Address - Street 1:1107 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4352
Practice Address - Country:US
Practice Address - Phone:601-425-2527
Practice Address - Fax:601-425-2528
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist