Provider Demographics
NPI:1972648483
Name:JOHNSON, CRAIG D (RPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:JOHNSON
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 1:1628 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3426
Mailing Address - Country:US
Mailing Address - Phone:701-282-9359
Mailing Address - Fax:
Practice Address - Street 1:100 4TH ST S
Practice Address - Street 2:SUITE 104
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1929
Practice Address - Country:US
Practice Address - Phone:701-237-0322
Practice Address - Fax:701-237-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist