Provider Demographics
NPI:1457560633
Name:CRAWFORD, PAUL RAYMOND
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RAYMOND
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 1:105 LONG RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-9413
Mailing Address - Country:US
Mailing Address - Phone:724-437-3285
Mailing Address - Fax:
Practice Address - Street 1:105 LONG RIDGE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-9413
Practice Address - Country:US
Practice Address - Phone:724-437-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027587L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist