Provider Demographics
NPI:1174930358
Name:BORGARDT, CRAIG JOHN (RPH)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOHN
Last Name:BORGARDT
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 1:6520 HIDDEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-9403
Mailing Address - Country:US
Mailing Address - Phone:262-681-2221
Mailing Address - Fax:
Practice Address - Street 1:6520 HIDDEN CREEK RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-9403
Practice Address - Country:US
Practice Address - Phone:262-681-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR9373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist