Healthcare Provider Details

I. General information

NPI: 1447003769
Provider Name (Legal Business Name): CRAIG'S DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 RACE ST
CAMBRIDGE MD
21613-1835
US

IV. Provider business mailing address

409 RACE ST
CAMBRIDGE MD
21613-1835
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-3322
  • Fax:
Mailing address:
  • Phone: 410-228-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYN KELLY
Title or Position: OWNER
Credential: PHARMD
Phone: 410-228-0058