Provider Demographics
NPI:1528305596
Name:CRAIG, ALVIE L
Entity type:Individual
Prefix:
First Name:ALVIE
Middle Name:L
Last Name:CRAIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9595 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-3930
Mailing Address - Country:US
Mailing Address - Phone:352-596-5190
Mailing Address - Fax:352-596-5495
Practice Address - Street 1:9595 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-3930
Practice Address - Country:US
Practice Address - Phone:352-596-5190
Practice Address - Fax:352-596-5495
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist