Provider Demographics
NPI:1033881594
Name:CRAIG, KENNETH JACOB (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JACOB
Last Name:CRAIG
Suffix:
Gender:M
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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0760
Mailing Address - Country:US
Mailing Address - Phone:406-338-8908
Mailing Address - Fax:406-338-6351
Practice Address - Street 1:760 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-8908
Practice Address - Fax:406-338-6351
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist