Provider Demographics
NPI:1043447451
Name:BURTON, CANDACE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 LOIS PL
Mailing Address - Street 2:APT 204
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3580
Mailing Address - Country:US
Mailing Address - Phone:815-725-1102
Mailing Address - Fax:815-725-7500
Practice Address - Street 1:1017 LOIS PL
Practice Address - Street 2:APT 204
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3580
Practice Address - Country:US
Practice Address - Phone:815-725-1102
Practice Address - Fax:815-725-7500
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049180742183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician