Michael Clyde Craddock, PHARMACIST 12

Primary specialty

PharmacistTaxonomy code 183500000X

License

4879 Issued in VA

Practice address

HC 34 Box 310
New Castle, VA 24127-9313

Phone

(540) 864-7063

NPI assigned

Jul 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457365652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC 34 BOX 310",
            "city": "NEW CASTLE",
            "state": "VA",
            "postal_code": "241279313",
            "telephone_number": "540-864-7063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HC 34 BOX 310",
            "city": "NEW CASTLE",
            "state": "VA",
            "postal_code": "241279313",
            "telephone_number": "540-864-7063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADDOCK",
        "first_name": "MICHAEL",
        "middle_name": "CLYDE",
        "name_prefix": "Mr.",
        "credential": "PHARMACIST 12",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "4879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kay Alley, SLP
• Michael W. Bradley, PHARMACY TECHNICIAN
• Commonwealth of Virginiastate Board of Health (Craig County Health Department)
• James Killinger Cornick, DDS
• Craig County Board of Supervisors
• Craig County Center
• Craig County Health Center - Lab
• Craig County Public Schools
• Craig County Public Schools

• Pharmacist in New Castle, VA
• Providers in New Castle, VA by specialty
• Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.