Provider Demographics
NPI:1659656619
Name:SMITH, CRAIG RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:RICHARD
Last Name:SMITH
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 1:7844 GRIMES PINE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-8735
Mailing Address - Country:US
Mailing Address - Phone:715-891-2019
Mailing Address - Fax:
Practice Address - Street 1:7844 GRIMES PINE LN
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-8735
Practice Address - Country:US
Practice Address - Phone:715-891-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11609-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist