Provider Demographics
NPI:1225328966
Name:ILLIG, CURTIS TODD (RPH)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:TODD
Last Name:ILLIG
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 1:8005 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5633
Mailing Address - Country:US
Mailing Address - Phone:919-771-1124
Mailing Address - Fax:919-772-9360
Practice Address - Street 1:8005 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-5633
Practice Address - Country:US
Practice Address - Phone:919-771-1124
Practice Address - Fax:919-772-9360
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist