Provider Demographics
NPI:1497025134
Name:BAILLOU, KANDYCE ANGE'LE (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:KANDYCE
Middle Name:ANGE'LE
Last Name:BAILLOU
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 1:3713 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7913
Mailing Address - Country:US
Mailing Address - Phone:813-727-3543
Mailing Address - Fax:813-242-6540
Practice Address - Street 1:2102 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1643
Practice Address - Country:US
Practice Address - Phone:813-759-8733
Practice Address - Fax:813-759-8182
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist