Provider Demographics
NPI:1609192210
Name:CREAMER, VAN C (RPH)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:C
Last Name:CREAMER
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 1:1461 SOUTH MAIN ST
Mailing Address - Street 2:PLAZA DISCOUNT PHARMACY;INC
Mailing Address - City:GRAYSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35073
Mailing Address - Country:US
Mailing Address - Phone:205-674-0680
Mailing Address - Fax:205-674-5157
Practice Address - Street 1:1461SOUTHMAINST
Practice Address - Street 2:PLAZADISCOUNTAPOTHECARY;INC
Practice Address - City:GRAYSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35073
Practice Address - Country:US
Practice Address - Phone:205-674-0680
Practice Address - Fax:205-674-5157
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist