=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447437629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE YVETTE GUYTON RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2008
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12525 LOCHLOOSA LN
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32218-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-766-5210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12525 LOCHLOOSA LN
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32218-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-766-5210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS28702
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------