Provider Demographics
NPI:1851990345
Name:DRIVER, CRAIG MICHAEL (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:DRIVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 HARTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3753
Mailing Address - Country:US
Mailing Address - Phone:308-830-9061
Mailing Address - Fax:
Practice Address - Street 1:1606 S 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1600
Practice Address - Country:US
Practice Address - Phone:402-393-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23857183500000X
NE16787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty