Provider Demographics
NPI:1912338013
Name:CRANE, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CRANE
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 1:15000 US 31
Mailing Address - Street 2:MEIJER PHARMACY
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8881
Mailing Address - Country:US
Mailing Address - Phone:616-847-8033
Mailing Address - Fax:616-847-8065
Practice Address - Street 1:15000 US 31
Practice Address - Street 2:MEIJER PHARMACY
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8881
Practice Address - Country:US
Practice Address - Phone:616-847-8033
Practice Address - Fax:616-847-8065
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist