Provider Demographics
NPI:1942617469
Name:CRAWFORD, MARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2029
Mailing Address - Country:US
Mailing Address - Phone:276-228-0637
Mailing Address - Fax:276-227-0203
Practice Address - Street 1:150 N 11TH ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2029
Practice Address - Country:US
Practice Address - Phone:276-228-0637
Practice Address - Fax:276-227-0203
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008864183500000X
VA0202213040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist