Provider Demographics
NPI:1437465333
Name:PURNELL, CEDRIC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:
Last Name:PURNELL
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 1:7251 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1410
Mailing Address - Country:US
Mailing Address - Phone:662-349-8336
Mailing Address - Fax:662-349-8337
Practice Address - Street 1:7251 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1410
Practice Address - Country:US
Practice Address - Phone:662-349-8336
Practice Address - Fax:662-349-8337
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010574183500000X
TN33825183500000X
ARPD11158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist