Healthcare Provider Details

I. General information

NPI: 1477780674
Provider Name (Legal Business Name): CRAIG ELG PHARM.D. BCOP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE E. 218
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR SUITE E. 218
PALM SPRINGS CA
92262-4800
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4853
  • Fax: 760-416-4726
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number54834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: