Provider Demographics
NPI:1144826421
Name:HENRY, CRAIG (PHARMD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:HENRY
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 1:704 W KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3709
Mailing Address - Country:US
Mailing Address - Phone:716-880-6024
Mailing Address - Fax:
Practice Address - Street 1:3745 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1001
Practice Address - Country:US
Practice Address - Phone:215-288-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454137183500000X
NJ28RI03471800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist