Provider Demographics
NPI:1932421500
Name:PETERSON, CRAIG NEIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:NEIL
Last Name:PETERSON
Suffix:
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 1:200 N BERTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2966
Mailing Address - Country:US
Mailing Address - Phone:630-993-5165
Mailing Address - Fax:630-993-5220
Practice Address - Street 1:200 N BERTEAU AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2966
Practice Address - Country:US
Practice Address - Phone:630-993-5165
Practice Address - Fax:630-993-5220
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051028953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist