Provider Demographics
NPI:1770186405
Name:MANDRELL, DARCI KAYE (RPH)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:KAYE
Last Name:MANDRELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2099
Mailing Address - Country:US
Mailing Address - Phone:618-937-2416
Mailing Address - Fax:618-932-6433
Practice Address - Street 1:309 W SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2099
Practice Address - Country:US
Practice Address - Phone:618-937-2416
Practice Address - Fax:618-932-6433
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist