Provider Demographics
NPI:1740860303
Name:PRYSE, CANDACE (PHARMACIST BS)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:PRYSE
Suffix:
Gender:F
Credentials:PHARMACIST BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FAUCHER RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-9738
Mailing Address - Country:US
Mailing Address - Phone:509-654-9738
Mailing Address - Fax:
Practice Address - Street 1:6600 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1976
Practice Address - Country:US
Practice Address - Phone:509-966-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA44776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist