Provider Demographics
NPI:1740764091
Name:SNOW-DAVIS, CANDACE MICHELLE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MICHELLE
Last Name:SNOW-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 JURY LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2955
Mailing Address - Country:US
Mailing Address - Phone:757-328-3021
Mailing Address - Fax:
Practice Address - Street 1:14260 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-3716
Practice Address - Country:US
Practice Address - Phone:757-874-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist