Provider Demographics
NPI:1093014409
Name:BAXTER, CRAIG W (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:BAXTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3538
Mailing Address - Country:US
Mailing Address - Phone:330-823-0850
Mailing Address - Fax:330-823-2566
Practice Address - Street 1:1895 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3538
Practice Address - Country:US
Practice Address - Phone:330-823-0850
Practice Address - Fax:330-823-2566
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-17361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist