Provider Demographics
NPI:1861942955
Name:CRAWFORD, MCKENSIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3090
Mailing Address - Country:US
Mailing Address - Phone:503-452-3033
Mailing Address - Fax:503-452-3027
Practice Address - Street 1:7555 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3090
Practice Address - Country:US
Practice Address - Phone:503-452-3033
Practice Address - Fax:503-452-3027
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015639183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist