Provider Demographics
NPI:1407524374
Name:SOTO, CANDACE ASHLEY (CPHT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ASHLEY
Last Name:SOTO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-5046
Mailing Address - Country:US
Mailing Address - Phone:361-664-1344
Mailing Address - Fax:
Practice Address - Street 1:1115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5046
Practice Address - Country:US
Practice Address - Phone:361-664-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197763183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician