Provider Demographics
NPI:1447802335
Name:CANDILORO, LANA LOCASCIO (RPH)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:LOCASCIO
Last Name:CANDILORO
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 1:6001 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4651
Mailing Address - Country:US
Mailing Address - Phone:409-962-4431
Mailing Address - Fax:
Practice Address - Street 1:6001 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4651
Practice Address - Country:US
Practice Address - Phone:409-962-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist