MEDICARE: DR. CANDACE NICOLE LENZEN PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	36109	TN

General Provider Information

NPI Number	:	1407143035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDACE NICOLE LENZEN PHARM.D.

Provider Business Mailing Address
First Line	:	3821 N MOUNT JULIET RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3048
Country	:	US
Telephone Number	:	706-207-8264
Fax Number	:

Provider Business Practice Location Address
First Line	:	11222 LEBANON RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-5504
Country	:	US
Telephone Number	:	615-773-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	07/04/2011

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