Provider Demographics
NPI:1407990534
Name:CREEL'S FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:CREEL'S FAMILY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-848-5555
Mailing Address - Street 1:26496 HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-7968
Mailing Address - Country:US
Mailing Address - Phone:985-848-5555
Mailing Address - Fax:985-848-4444
Practice Address - Street 1:26496 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-7968
Practice Address - Country:US
Practice Address - Phone:985-848-5555
Practice Address - Fax:985-848-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4171333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330477Medicaid
LA1266833Medicaid