=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407990534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREEL'S FAMILY PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26496 HIGHWAY 62
-----------------------------------------------------
City | FRANKLINTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70438-7968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-848-5555
-----------------------------------------------------
Fax | 985-848-4444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26496 HIGHWAY 62
-----------------------------------------------------
City | FRANKLINTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70438-7968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-848-5555
-----------------------------------------------------
Fax | 985-848-4444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAMES RANDOLPH CREEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 985-848-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 4171
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------