Provider Demographics
NPI:1598242307
Name:CANTRELL, JAMES WESLEY (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WESLEY
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-2541
Mailing Address - Country:US
Mailing Address - Phone:334-718-0430
Mailing Address - Fax:
Practice Address - Street 1:1226 FREEPORT HWY S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3396
Practice Address - Country:US
Practice Address - Phone:850-892-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11991183500000X
FLPS54669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist