Provider Demographics
NPI:1710466941
Name:CULLOP, CANDACE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:CULLOP
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 1:115 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3606
Mailing Address - Country:US
Mailing Address - Phone:158-033-8756
Mailing Address - Fax:
Practice Address - Street 1:115 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3606
Practice Address - Country:US
Practice Address - Phone:158-033-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist