Healthcare Provider Details

I. General information

NPI: 1104404177
Provider Name (Legal Business Name): CANDICE LIU POLLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DALE AVE
BENTON CITY WA
99320-5250
US

IV. Provider business mailing address

701 DALE AVE
BENTON CITY WA
99320-5250
US

V. Phone/Fax

Practice location:
  • Phone: 509-588-4075
  • Fax:
Mailing address:
  • Phone: 509-588-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD.MD.61570197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: