Basic Information
| Provider Information | |||||||||
| NPI: | 1811270853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAFTON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 E ERIE ST | ||||||||
| Address2: | APT E313 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658046439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145705777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1820 S SPRINGFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656132563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177773700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2011 | ||||||||
| LastUpdateDate: | 09/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2010028710 | MO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.