Provider Demographics
NPI:1760075543
Name:CREEDON, CRISTIN ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:ELIZABETH
Last Name:CREEDON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4404 INDIAN DRAFT RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-5606
Mailing Address - Country:US
Mailing Address - Phone:540-958-8746
Mailing Address - Fax:
Practice Address - Street 1:200 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6444
Practice Address - Country:US
Practice Address - Phone:540-958-8746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist