Provider Demographics
NPI:1508897190
Name:TETREAU, CRAIG RICHARD (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:RICHARD
Last Name:TETREAU
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:MR
Other - First Name:CRAIG
Other - Middle Name:RICHARD
Other - Last Name:TETREAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:7041 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9677
Mailing Address - Country:US
Mailing Address - Phone:989-453-2852
Mailing Address - Fax:
Practice Address - Street 1:168 N. CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755
Practice Address - Country:US
Practice Address - Phone:989-453-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist