Provider Demographics
NPI:1508976804
Name:MCALISTER, CRAIG WESLEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WESLEY
Last Name:MCALISTER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4438
Mailing Address - Country:US
Mailing Address - Phone:405-354-4310
Mailing Address - Fax:
Practice Address - Street 1:2600 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-1801
Practice Address - Country:US
Practice Address - Phone:405-354-2582
Practice Address - Fax:405-350-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3702176Medicare UPIN
OK0927130001Medicare ID - Type Unspecified