Provider Demographics
NPI:1285207290
Name:AHRENS, CANDY TWNN
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:TWNN
Last Name:AHRENS
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 1:1500 ANNA SPARKS WAY STE D
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4170
Mailing Address - Country:US
Mailing Address - Phone:707-839-0140
Mailing Address - Fax:707-839-0251
Practice Address - Street 1:1500 ANNA SPARKS WAY STE D
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4170
Practice Address - Country:US
Practice Address - Phone:707-839-0140
Practice Address - Fax:707-839-0251
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50142183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician