Healthcare Provider Details

I. General information

NPI: 1144568940
Provider Name (Legal Business Name): CANDICE MARIE FAITH KIELION CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 AIRPORT COMMERCE DR STE 350
AUSTIN TX
78741-6836
US

IV. Provider business mailing address

1521 SOUTHPORT DR #C
AUSTIN TX
78704-7805
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-8877
  • Fax: 512-628-8878
Mailing address:
  • Phone: 512-628-8877
  • Fax: 512-628-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number163714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: