Provider Demographics
NPI:1922353002
Name:CRAIG, JESSICA KATHERINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHERINE
Last Name:CRAIG
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 1:4049 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3426
Mailing Address - Country:US
Mailing Address - Phone:540-725-1546
Mailing Address - Fax:
Practice Address - Street 1:4049 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3426
Practice Address - Country:US
Practice Address - Phone:540-725-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist