Provider Demographics
NPI:1487731303
Name:CREEL, RANDALL EDWIN
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:EDWIN
Last Name:CREEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RANDALL
Other - Middle Name:EDWIN
Other - Last Name:CREEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:121 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2211
Mailing Address - Country:US
Mailing Address - Phone:256-878-0641
Mailing Address - Fax:256-878-0642
Practice Address - Street 1:121 S BROAD ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-2211
Practice Address - Country:US
Practice Address - Phone:256-878-0641
Practice Address - Fax:256-878-0642
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist