Provider Demographics
NPI:1376837351
Name:ANGELILLI, CANDICE ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:ANN
Last Name:ANGELILLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MARTIN BLVD
Mailing Address - Street 2:T-1970
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4104
Mailing Address - Country:US
Mailing Address - Phone:410-406-9082
Mailing Address - Fax:443-868-3113
Practice Address - Street 1:1330 MARTIN BLVD
Practice Address - Street 2:T-1970
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-4104
Practice Address - Country:US
Practice Address - Phone:410-406-9082
Practice Address - Fax:443-868-3113
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist