Provider Demographics
NPI:1306439922
Name:CRANE, MARY A
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:CRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-0572
Mailing Address - Country:US
Mailing Address - Phone:574-268-8154
Mailing Address - Fax:
Practice Address - Street 1:1775 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3603
Practice Address - Country:US
Practice Address - Phone:574-267-7356
Practice Address - Fax:574-267-1599
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016113A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist