Provider Demographics
NPI:1992879415
Name:CRAWFORD PROFESSIONAL DRUGS INC
Entity type:Organization
Organization Name:CRAWFORD PROFESSIONAL DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRES, PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:TRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:REG PHARM
Authorized Official - Phone:601-425-2527
Mailing Address - Street 1:240 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4226
Mailing Address - Country:US
Mailing Address - Phone:601-425-2527
Mailing Address - Fax:601-425-2528
Practice Address - Street 1:240 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4226
Practice Address - Country:US
Practice Address - Phone:601-425-2527
Practice Address - Fax:601-425-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MS010980113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030708Medicaid
2050527OtherPK
2050527OtherPK