Provider Demographics
NPI:1053498089
Name:O'MALLAN, KANDACE ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KANDACE
Middle Name:ANN
Last Name:O'MALLAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KANDACE
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2700 SEVENTH STREET
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414
Mailing Address - Country:US
Mailing Address - Phone:979-245-1881
Mailing Address - Fax:979-244-1945
Practice Address - Street 1:2700 7TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-5305
Practice Address - Country:US
Practice Address - Phone:979-245-1881
Practice Address - Fax:979-244-1945
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist