Provider Demographics
NPI:1417407396
Name:CORDELL, CRYSTAL D (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:CORDELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 S SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7224
Mailing Address - Country:US
Mailing Address - Phone:870-307-0262
Mailing Address - Fax:870-307-0220
Practice Address - Street 1:1045 S SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7224
Practice Address - Country:US
Practice Address - Phone:870-307-0262
Practice Address - Fax:870-307-0220
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist