Provider Demographics
NPI:1033390760
Name:HENRY, CRAIG PHILLIP
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:PHILLIP
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 PARK AVE
Mailing Address - Street 2:RITE AID
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2943
Mailing Address - Country:US
Mailing Address - Phone:585-271-6011
Mailing Address - Fax:
Practice Address - Street 1:626 PARK AVE
Practice Address - Street 2:RITE AID
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2943
Practice Address - Country:US
Practice Address - Phone:585-271-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist