Provider Demographics
NPI:1689198434
Name:CRAFT, DAKOTA MARIE THAXTON (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DAKOTA
Middle Name:MARIE THAXTON
Last Name:CRAFT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 LOUISE ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-2405
Mailing Address - Country:US
Mailing Address - Phone:678-588-4047
Mailing Address - Fax:
Practice Address - Street 1:1602 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1269
Practice Address - Country:US
Practice Address - Phone:770-227-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist