Provider Demographics
NPI:1740885326
Name:DANNEHL, CRAIG
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:DANNEHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MARLBOROUGH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1222
Mailing Address - Country:US
Mailing Address - Phone:308-991-4455
Mailing Address - Fax:
Practice Address - Street 1:21 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3502
Practice Address - Country:US
Practice Address - Phone:617-242-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist