Provider Demographics
NPI:1144545625
Name:CRANDELL, PAULA KAY (RPH)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-9714
Mailing Address - Country:US
Mailing Address - Phone:269-274-0379
Mailing Address - Fax:
Practice Address - Street 1:714 SHOPPERS LN
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1118
Practice Address - Country:US
Practice Address - Phone:269-349-7322
Practice Address - Fax:269-349-4819
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist