Provider Demographics
NPI:1043962509
Name:WHITLEY, CANDACE MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:MICHELLE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-8048
Mailing Address - Country:US
Mailing Address - Phone:870-642-5680
Mailing Address - Fax:870-642-5683
Practice Address - Street 1:500 E COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-8048
Practice Address - Country:US
Practice Address - Phone:870-642-5680
Practice Address - Fax:870-642-5683
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist