Individual
MR. BARRY DAYTON CRIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
101 W SWEET POTATO ST, VARDAMAN, MS 38878-9433
(662) 682-7489
Mailing address
2504 PHILP DR, TUPELO, MS 38801-6109
(662) 549-5232
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-07893
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800278784
MS DRIVERS LICENSE
MS
01
—
E-07893
MS BOARD OF PHARMACY LICENSE
MS
Enumeration date
08/24/2017
Last updated
06/20/2018
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