Provider Demographics
NPI:1144568940
Name:KIELION, CANDICE MARIE FAITH (CPHT)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:MARIE FAITH
Last Name:KIELION
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SOUTHPORT DR
Mailing Address - Street 2:#C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7805
Mailing Address - Country:US
Mailing Address - Phone:512-628-8877
Mailing Address - Fax:512-628-8878
Practice Address - Street 1:1340 AIRPORT COMMERCE DR STE 350
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6836
Practice Address - Country:US
Practice Address - Phone:512-628-8877
Practice Address - Fax:512-628-8878
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163714183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician