Healthcare Provider Details

I. General information

NPI: 1326126764
Provider Name (Legal Business Name): CRAIG DONALDSON R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SLATE AVE.
OWINGSVILLE KY
40360
US

IV. Provider business mailing address

1432 BIG STONER RD
WINCHESTER KY
40391-9637
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012799
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: