Provider Demographics
NPI:1538351960
Name:CANTRELL, KEITH HOLLEY (RPH)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:HOLLEY
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 THOROUGHBRED TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6238
Mailing Address - Country:US
Mailing Address - Phone:256-722-4796
Mailing Address - Fax:256-830-2206
Practice Address - Street 1:8050 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9567
Practice Address - Country:US
Practice Address - Phone:256-830-1630
Practice Address - Fax:256-830-2206
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist