Provider Demographics
NPI:1578949863
Name:PUDDER, CANDICE D (PHARMD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:D
Last Name:PUDDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-6005
Mailing Address - Fax:304-335-6009
Practice Address - Street 1:1 POLING STREET
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-0247
Practice Address - Country:US
Practice Address - Phone:304-335-6005
Practice Address - Fax:304-335-6009
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006643183500000X
MD16689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist