Andy Crandell
Individual provider Active NPI Pharmacist · Payson, AZ
NPI 1619214525 · NPPES record last updated Jan 11, 2013
Key facts
- NPI
- 1619214525
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- S019468 (AZ)
- Practice address
- 401 East Highway 260
Payson, AZ 85541 - Phone
- (928) 472-8242
- NPI assigned
- Jan 11, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S019468 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S019468 | AZ | Yes |
Addresses
Primary practice location
401 East Highway 260
Payson, AZ 85541
Mailing address
401 E Highway 260
Payson, AZ 85541
Phone (928) 472-8242
Other providers in Payson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.