Provider Demographics
NPI:1477002756
Name:CRAIG, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 E RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5873
Mailing Address - Country:US
Mailing Address - Phone:312-285-7482
Mailing Address - Fax:
Practice Address - Street 1:2323 E RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5873
Practice Address - Country:US
Practice Address - Phone:312-285-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036859183500000X, 1835C0205X, 1835P0200X, 1835P1200X
IL051-0368591835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835C0205XPharmacy Service ProvidersPharmacistCritical Care
No1835P0200XPharmacy Service ProvidersPharmacistPediatrics
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy