Healthcare Provider Details

I. General information

NPI: 1134718760
Provider Name (Legal Business Name): CANDACE WEST RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 US HIGHWAY 278 E
HOKES BLUFF AL
35903-7204
US

IV. Provider business mailing address

5702 US HIGHWAY 278 E
HOKES BLUFF AL
35903-7204
US

V. Phone/Fax

Practice location:
  • Phone: 256-494-1918
  • Fax: 256-494-1925
Mailing address:
  • Phone: 256-494-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13667
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: