Provider Demographics
NPI:1003839721
Name:CRAIG, JOHN HOWARD (PD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HOWARD
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SPAULDING DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-5901
Mailing Address - Country:US
Mailing Address - Phone:812-752-0526
Mailing Address - Fax:812-752-7688
Practice Address - Street 1:120 W MCCLAIN AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-2046
Practice Address - Country:US
Practice Address - Phone:812-752-2021
Practice Address - Fax:812-752-7688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013285A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist