Provider Demographics
NPI:1508821869
Name:VAN TASSELL, CRAIG C (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:C
Last Name:VAN TASSELL
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 N MAIN ST
Mailing Address - Street 2:P.O. BOX 67
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9540
Mailing Address - Country:US
Mailing Address - Phone:435-783-4466
Mailing Address - Fax:
Practice Address - Street 1:40 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9540
Practice Address - Country:US
Practice Address - Phone:435-783-4466
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1222631703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist