Provider Demographics
NPI:1407151319
Name:CRAIG, BARRY EDWARD (DPH)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:EDWARD
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1063
Mailing Address - Country:US
Mailing Address - Phone:931-729-1177
Mailing Address - Fax:
Practice Address - Street 1:1797 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1063
Practice Address - Country:US
Practice Address - Phone:931-729-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist