Provider Demographics
NPI:1275886889
Name:BREWER, KANDICE LYNN (RPH)
Entity Type:Individual
Prefix:MS
First Name:KANDICE
Middle Name:LYNN
Last Name:BREWER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STANTON ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1630
Mailing Address - Country:US
Mailing Address - Phone:340-998-0627
Mailing Address - Fax:
Practice Address - Street 1:1564 E 174TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1203
Practice Address - Country:US
Practice Address - Phone:718-618-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist