Provider Demographics
NPI:1568943462
Name:PEARSON, KANDYCE NICOLE (PHARMD, RPH, MSPH,)
Entity Type:Individual
Prefix:
First Name:KANDYCE
Middle Name:NICOLE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHARMD, RPH, MSPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 CHARLENE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1552
Mailing Address - Country:US
Mailing Address - Phone:310-864-4916
Mailing Address - Fax:
Practice Address - Street 1:1800 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1126
Practice Address - Country:US
Practice Address - Phone:323-292-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist