Provider Demographics
NPI:1831221332
Name:STERN, CRAIG STEPHEN (RPH, PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEPHEN
Last Name:STERN
Suffix:
Gender:M
Credentials:RPH, PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 TOPEKA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1224
Mailing Address - Country:US
Mailing Address - Phone:818-701-5973
Mailing Address - Fax:818-993-8521
Practice Address - Street 1:9221 CORBIN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2483
Practice Address - Country:US
Practice Address - Phone:818-701-5438
Practice Address - Fax:818-701-0249
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH30413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH30413OtherCA LICENSE NUMBER