Provider Demographics
NPI:1467722165
Name:CRANDALL, MARCY LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:LYNN
Last Name:CRANDALL
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 1:8706 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3705
Mailing Address - Country:US
Mailing Address - Phone:813-885-2766
Mailing Address - Fax:813-885-4740
Practice Address - Street 1:8706 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3705
Practice Address - Country:US
Practice Address - Phone:813-885-2766
Practice Address - Fax:813-885-4740
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist