Provider Demographics
NPI:1154611135
Name:CRAWFORD, RANDY GORDON (RPH)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:GORDON
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N WINSTEAD AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-443-7979
Mailing Address - Fax:252-937-7143
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:STE 100
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-443-7979
Practice Address - Fax:252-937-7143
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist