Provider Demographics
NPI:1093974925
Name:CRAFT, LONNIE JOE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:JOE
Last Name:CRAFT
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-0126
Mailing Address - Country:US
Mailing Address - Phone:614-573-1557
Mailing Address - Fax:
Practice Address - Street 1:480 S JEFFERSON AVE
Practice Address - Street 2:STE 200
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-4137
Practice Address - Country:US
Practice Address - Phone:614-873-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03221205OtherPHARMACIST LICENSE