Provider Demographics
NPI:1427181213
Name:MIKLASIEWICZ, CRAIG A (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:MIKLASIEWICZ
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 1:40 NORWOOD TER
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1710
Mailing Address - Country:US
Mailing Address - Phone:413-540-0192
Mailing Address - Fax:
Practice Address - Street 1:506 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1633
Practice Address - Country:US
Practice Address - Phone:413-536-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24081183500000X
CT9120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2237914OtherNABP
CT9120OtherCT RPH LICENSE NUMBER
MA24081OtherMA RPH LICENSE
MA0448141Medicaid