Provider Demographics
NPI:1649798877
Name:CRAIG, MARY RAY (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:RAY
Last Name:CRAIG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3327
Mailing Address - Country:US
Mailing Address - Phone:662-534-4731
Mailing Address - Fax:662-534-4732
Practice Address - Street 1:FRED'S PHARMACY 126 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652
Practice Address - Country:US
Practice Address - Phone:662-534-4731
Practice Address - Fax:662-534-4732
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist