Provider Demographics
NPI:1053973214
Name:CRAIG, COREY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1402
Mailing Address - Country:US
Mailing Address - Phone:718-323-8377
Mailing Address - Fax:
Practice Address - Street 1:57 W 58TH ST APT 7H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1611
Practice Address - Country:US
Practice Address - Phone:917-292-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist