Basic Information
| Provider Information | |||||||||
| NPI: | 1093765471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRANE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR#1 BOX62C | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123843460 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | RR#1 BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128472281 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 26012892A | IN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.