Provider Demographics
NPI:1124785357
Name:EATON, CRAIG STEPHEN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEPHEN
Last Name:EATON
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 1:4415 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-9295
Mailing Address - Country:US
Mailing Address - Phone:540-769-7380
Mailing Address - Fax:
Practice Address - Street 1:4415 LAKE RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:TN
Practice Address - Zip Code:37191-9295
Practice Address - Country:US
Practice Address - Phone:270-798-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist