Provider Demographics
NPI:1659659787
Name:CRAIG-WILDER, CATHERINE ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANNE
Last Name:CRAIG-WILDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 FOX RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8665
Mailing Address - Country:US
Mailing Address - Phone:336-945-6421
Mailing Address - Fax:
Practice Address - Street 1:200 E 10TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1512
Practice Address - Country:US
Practice Address - Phone:336-770-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist