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NPI Code Detail

MEDICARE: KRISTAN CREEL

MEDICARE: KRISTAN CREEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051040693IL

General Provider Information

NPI Number : 1225632805
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTAN CREEL
Provider Business Mailing Address
First Line : 845 BROADMEADOW RD
Second Line :
City : RANTOUL
State : IL
Zip : 61866-2119
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 845 BROADMEADOW RD
Second Line :
City : RANTOUL
State : IL
Zip : 61866-2119
Country : US
Telephone Number : 217-892-9171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2020
Last Update Date : 11/24/2020

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Directions to “ KRISTAN CREEL ” Practice Location

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