Provider Demographics
NPI:1588030431
Name:CRAIG-WANKIIRI, IDAH
Entity Type:Individual
Prefix:MRS
First Name:IDAH
Middle Name:
Last Name:CRAIG-WANKIIRI
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 1:567 COLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-6850
Mailing Address - Country:US
Mailing Address - Phone:570-223-7183
Mailing Address - Fax:
Practice Address - Street 1:567 COLD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-6850
Practice Address - Country:US
Practice Address - Phone:570-223-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043399L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist