Healthcare Provider Details

I. General information

NPI: 1144985359
Provider Name (Legal Business Name): CANDICE ANN JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AIRPORT DR
BAKERSFIELD CA
93308-4129
US

IV. Provider business mailing address

715 AIRPORT DR
BAKERSFIELD CA
93308-4129
US

V. Phone/Fax

Practice location:
  • Phone: 661-392-7059
  • Fax: 661-392-7091
Mailing address:
  • Phone: 661-392-7059
  • Fax: 661-392-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number72189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: