Provider Demographics
NPI:1295224772
Name:MATHIS, CANDICE S (PHARM D)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:S
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0297
Mailing Address - Country:US
Mailing Address - Phone:252-357-1226
Mailing Address - Fax:252-357-1236
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938-9424
Practice Address - Country:US
Practice Address - Phone:252-357-1226
Practice Address - Fax:252-357-1236
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist