Healthcare Provider Details

I. General information

NPI: 1851444657
Provider Name (Legal Business Name): CRAIG W TROBAUGH R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LACEY CIRCLE
POOLER GA
31322
US

IV. Provider business mailing address

3 LACEY CIRCLE
POOLER GA
31322-1258
US

V. Phone/Fax

Practice location:
  • Phone: 765-524-4321
  • Fax:
Mailing address:
  • Phone: 912-450-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number26013193
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: