Provider Demographics
NPI:1295005817
Name:TIMMONS, CANDACE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:TIMMONS
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 1:3182 LAKE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-6321
Mailing Address - Country:US
Mailing Address - Phone:941-979-9442
Mailing Address - Fax:941-979-9448
Practice Address - Street 1:22449 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2016
Practice Address - Country:US
Practice Address - Phone:941-625-4346
Practice Address - Fax:941-625-1287
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 35728183500000X
IA18929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist