Provider Demographics
NPI:1518260728
Name:LAWRENZ, CANDACE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:LAWRENZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 CAMINO DEL REY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1555
Mailing Address - Country:US
Mailing Address - Phone:719-526-6110
Mailing Address - Fax:719-524-7808
Practice Address - Street 1:1650 COCHRANE CIR BLDG 7500
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7160
Practice Address - Fax:719-526-4903
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI25716183500000X
MI53020257161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist