MEDICARE: KANDYCE NICOLE PEARSON PHARMD, RPH, MSPH,

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	78456	CA

General Provider Information

NPI Number	:	1568943462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDYCE NICOLE PEARSON PHARMD, RPH, MSPH,

Provider Business Mailing Address
First Line	:	4175 CHARLENE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1552
Country	:	US
Telephone Number	:	310-864-4916
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1126
Country	:	US
Telephone Number	:	323-292-1941
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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