Provider Demographics
NPI:1831540996
Name:CRANDELL, INEZ
Entity type:Individual
Prefix:
First Name:INEZ
Middle Name:
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9146
Mailing Address - Country:US
Mailing Address - Phone:616-250-6266
Mailing Address - Fax:231-796-8722
Practice Address - Street 1:21400 PERRY AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9262
Practice Address - Country:US
Practice Address - Phone:231-796-3691
Practice Address - Fax:231-796-8722
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist