Provider Demographics
NPI:1619145851
Name:CRAIN, ROBERT E (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:CRAIN
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 1:625 3RD AVE EXT
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-5618
Mailing Address - Country:US
Mailing Address - Phone:518-283-2572
Mailing Address - Fax:518-283-2572
Practice Address - Street 1:625 3RD AVE EXT
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-5618
Practice Address - Country:US
Practice Address - Phone:518-283-2572
Practice Address - Fax:518-283-2572
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist