Provider Demographics
NPI:1154341337
Name:WILLIMANN, CRAIG NEAL (RPH)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:NEAL
Last Name:WILLIMANN
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 1:100 DWAYNE VONBEHREN DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-2251
Mailing Address - Country:US
Mailing Address - Phone:573-237-2912
Mailing Address - Fax:573-237-2005
Practice Address - Street 1:100 DWAYNE VONBEHREN DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-2251
Practice Address - Country:US
Practice Address - Phone:573-237-2912
Practice Address - Fax:573-237-2005
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600447007Medicaid
MO620447003Medicaid
MO620447003Medicaid