Provider Demographics
NPI:1316431448
Name:TINDLE, REBECCA CRENSHAW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:CRENSHAW
Last Name:TINDLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 MAGNOLIA CREST LN
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-2701
Mailing Address - Country:US
Mailing Address - Phone:205-960-5588
Mailing Address - Fax:
Practice Address - Street 1:2200 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004
Practice Address - Country:US
Practice Address - Phone:205-640-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20361OtherPHARMACIST LICENSE