Provider Demographics
NPI:1780866723
Name:CRANK, PHILIP L JR (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:L
Last Name:CRANK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-3103
Mailing Address - Country:US
Mailing Address - Phone:518-585-6486
Mailing Address - Fax:518-585-7938
Practice Address - Street 1:1134 WICKER ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-3103
Practice Address - Country:US
Practice Address - Phone:518-585-6486
Practice Address - Fax:518-585-7938
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist