Provider Demographics
NPI:1043687544
Name:CRAFT, VICKIE LINTON (RPH)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LINTON
Last Name:CRAFT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5186 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117-3605
Mailing Address - Country:US
Mailing Address - Phone:601-732-8683
Mailing Address - Fax:601-732-6303
Practice Address - Street 1:5186 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MS
Practice Address - Zip Code:39117-3605
Practice Address - Country:US
Practice Address - Phone:601-732-8683
Practice Address - Fax:601-732-6303
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-07070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist