Healthcare Provider Details

I. General information

NPI: 1225134141
Provider Name (Legal Business Name): CANDACE L KUIPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 3RD ST N
GREAT FALLS MT
59401-3188
US

IV. Provider business mailing address

4430 5TH AVE S
GREAT FALLS MT
59405-3739
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2399
  • Fax:
Mailing address:
  • Phone: 406-781-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: