Provider Demographics
NPI:1053939686
Name:ANDERSON, CANDACE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:ANDERSON
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 1:18920 MOONWALK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6119
Mailing Address - Country:US
Mailing Address - Phone:808-989-0959
Mailing Address - Fax:
Practice Address - Street 1:18920 MOONWALK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-6119
Practice Address - Country:US
Practice Address - Phone:808-989-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27117183500000X
WAPH.60935565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist