Provider Demographics
NPI:1063592863
Name:CRIPPEN, CRAIG (RPH)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:CRIPPEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 MARILYN DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9417
Mailing Address - Country:US
Mailing Address - Phone:801-391-8523
Mailing Address - Fax:
Practice Address - Street 1:1055 W HILL FIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4614
Practice Address - Country:US
Practice Address - Phone:801-444-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3082584-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist