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General NPI Number Information
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NPI Number | 1578174272
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Entity Type | Individual
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Provider Name | CANDACE S MATHIS DPH
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 4702 LASCASSAS PIKE
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City | LASCASSAS
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State | TN
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Zip | 37085-4511
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Country | US
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Telephone | 615-896-9808
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Fax |
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Provider Business Mailing Address
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Address Line | 12001 ELROD MCELROY RD
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City | MILTON
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State | TN
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Zip | 37118-4226
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Country | US
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Telephone | 615-542-7772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8504
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License Number State | TN
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