Provider Demographics
NPI:1235734930
Name:CANTRELL, DUSTIN COLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:COLE
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 LANGSTON RD
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-8192
Mailing Address - Country:US
Mailing Address - Phone:662-308-8591
Mailing Address - Fax:
Practice Address - Street 1:750 CITY AVE S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2520
Practice Address - Country:US
Practice Address - Phone:662-837-4444
Practice Address - Fax:662-837-4443
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist