Provider Demographics
NPI:1407125149
Name:JAY, CRAIG P (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:P
Last Name:JAY
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 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-9215
Mailing Address - Country:US
Mailing Address - Phone:417-533-6770
Mailing Address - Fax:417-533-6777
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9215
Practice Address - Country:US
Practice Address - Phone:417-533-6770
Practice Address - Fax:417-533-6777
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist