Provider Demographics
NPI:1205013083
Name:HELLMUTH, CRAIG M (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:M
Last Name:HELLMUTH
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 1:1500 WASHINGTON ST.
Mailing Address - Street 2:APT. 6A
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6736
Mailing Address - Country:US
Mailing Address - Phone:201-459-9732
Mailing Address - Fax:
Practice Address - Street 1:1500 WASHINGTON ST.
Practice Address - Street 2:APT. 6A
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6736
Practice Address - Country:US
Practice Address - Phone:201-459-9732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02633100183500000X
NY041413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01714438Medicaid