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NPI Code Detail

MEDICARE: KRISTI VAUGHN CANTRELL RPH

MEDICARE: KRISTI VAUGHN CANTRELL RPH
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
1183500000XPharmacist12202AL

General Provider Information

NPI Number : 1487098539
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTI VAUGHN CANTRELL RPH
Provider Business Mailing Address
First Line : 100 N AIRPORT RD
Second Line :
City : JASPER
State : AL
Zip : 35504-7520
Country : US
Telephone Number : 205-221-3150
Fax Number : 205-221-9850
Provider Business Practice Location Address
First Line : 100 N AIRPORT RD
Second Line :
City : JASPER
State : AL
Zip : 35504-7520
Country : US
Telephone Number : 205-221-3150
Fax Number : 205-221-9850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2013
Last Update Date : 04/19/2013

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