=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619331915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG HITCHMAN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2016
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 E YORBA LINDA BLVD
-----------------------------------------------------
City | PLACENTIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92870-3828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-982-1708
-----------------------------------------------------
Fax | 714-982-1709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 PEONY
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-293-8839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH43820
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------