Provider Demographics
NPI:1821411083
Name:CRAIG, KATHLEEN LOUISE
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:CRAIG
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 1:1525 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3411
Mailing Address - Country:US
Mailing Address - Phone:602-439-9867
Mailing Address - Fax:602-439-9869
Practice Address - Street 1:1525 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3411
Practice Address - Country:US
Practice Address - Phone:602-439-9867
Practice Address - Fax:602-439-9869
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist