Provider Demographics
NPI:1528651171
Name:OUELLETTE, CRAIG WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:79095-3738
Mailing Address - Country:US
Mailing Address - Phone:806-447-1184
Mailing Address - Fax:
Practice Address - Street 1:1016 16TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:TX
Practice Address - Zip Code:79095-3738
Practice Address - Country:US
Practice Address - Phone:806-447-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist