Healthcare Provider Details

I. General information

NPI: 1518847458
Provider Name (Legal Business Name): CANDACE N VIADA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 E BROAD ST
STATESVILLE NC
28625-4306
US

IV. Provider business mailing address

12561 JESSICA PL
CHARLOTTE NC
28269-1579
US

V. Phone/Fax

Practice location:
  • Phone: 704-872-8131
  • Fax:
Mailing address:
  • Phone: 704-388-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33963
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: