Provider Demographics
NPI:1396345393
Name:CRATEM, PHILIP II (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:CRATEM
Suffix:II
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 1:2229 SMULLIAN TRL N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-3534
Mailing Address - Country:US
Mailing Address - Phone:190-469-9291
Mailing Address - Fax:
Practice Address - Street 1:8808 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4621
Practice Address - Country:US
Practice Address - Phone:904-646-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist