Provider Demographics
NPI:1922318070
Name:CREDILLE, STACY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:CREDILLE
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 1:525 4TH AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582
Mailing Address - Country:US
Mailing Address - Phone:256-356-4540
Mailing Address - Fax:
Practice Address - Street 1:525 4TH AVE
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582
Practice Address - Country:US
Practice Address - Phone:256-356-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist