Provider Demographics
NPI:1780280669
Name:CRANE, KARA
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 W FULTON PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7676
Mailing Address - Country:US
Mailing Address - Phone:580-302-1607
Mailing Address - Fax:
Practice Address - Street 1:WALMART PHARMACY #207
Practice Address - Street 2:772 N AIRPORT RD
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020
Practice Address - Country:US
Practice Address - Phone:918-358-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist