Provider Demographics
NPI:1851444657
Name:TROBAUGH, CRAIG W (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:TROBAUGH
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 1:3 LACEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-1258
Mailing Address - Country:US
Mailing Address - Phone:912-450-1338
Mailing Address - Fax:
Practice Address - Street 1:3 LACEY CIRCLE
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322
Practice Address - Country:US
Practice Address - Phone:765-524-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN260131931835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26013193OtherPHARMACIST LICENSE