Provider Demographics
NPI:1659898328
Name:CRIDDLE, BARRY DAYTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:DAYTON
Last Name:CRIDDLE
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 1:2504 PHILP DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6109
Mailing Address - Country:US
Mailing Address - Phone:662-549-5232
Mailing Address - Fax:
Practice Address - Street 1:101 W SWEET POTATO ST
Practice Address - Street 2:
Practice Address - City:VARDAMAN
Practice Address - State:MS
Practice Address - Zip Code:38878-9433
Practice Address - Country:US
Practice Address - Phone:662-682-7489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-07893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800278784OtherMS DRIVERS LICENSE
MSE-07893OtherMS BOARD OF PHARMACY LICENSE
MS800278784OtherMS DRIVERS LICENSE