Healthcare Provider Details

I. General information

NPI: 1548662059
Provider Name (Legal Business Name): CANDACE MARIE POULES PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 WEHRLE DR
WILLIAMSVILLE NY
14221-7748
US

IV. Provider business mailing address

30 MCKENZIE CT
CHEEKTOWAGA NY
14227-3237
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-3381
  • Fax:
Mailing address:
  • Phone: 716-341-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20 059930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: