Provider Demographics
NPI:1457948663
Name:CRELIA, VERNON
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:CRELIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PRESTON GLN
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-9503
Mailing Address - Country:US
Mailing Address - Phone:214-566-8539
Mailing Address - Fax:
Practice Address - Street 1:1670 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3444
Practice Address - Country:US
Practice Address - Phone:972-562-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist