Provider Demographics
NPI:1437433265
Name:JOHNSON, CANDICE NICHOLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:NICHOLE
Last Name:JOHNSON
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 1:1226 SUMMER LYNNE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-6311
Mailing Address - Country:US
Mailing Address - Phone:314-243-9708
Mailing Address - Fax:
Practice Address - Street 1:696 N HIGHWAY 67 ST
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5106
Practice Address - Country:US
Practice Address - Phone:314-830-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist