Provider Demographics
NPI:1922583749
Name:CRAWFORD, BREANNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6523
Mailing Address - Country:US
Mailing Address - Phone:575-885-1029
Mailing Address - Fax:
Practice Address - Street 1:2401 S CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-6523
Practice Address - Country:US
Practice Address - Phone:575-885-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62716183500000X
NMRP00008938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist