Provider Demographics
NPI:1609009794
Name:MCCREADY, CARL ALEXANDER SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:ALEXANDER
Last Name:MCCREADY
Suffix:SR
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 1:15043 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9328
Mailing Address - Country:US
Mailing Address - Phone:231-627-6465
Mailing Address - Fax:
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1637
Practice Address - Country:US
Practice Address - Phone:231-627-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302023746OtherPHARMACIST LICENSE NUMBER