Provider Demographics
NPI:1619128154
Name:BULL, CANDACE ROMAINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ROMAINE
Last Name:BULL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:ROMAINE
Other - Last Name:VANDERLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2725
Mailing Address - Country:US
Mailing Address - Phone:801-546-6352
Mailing Address - Fax:
Practice Address - Street 1:860 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2725
Practice Address - Country:US
Practice Address - Phone:801-546-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5123256-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist