Provider Demographics
NPI:1780222695
Name:MCQUEEN, CANDACE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:MCQUEEN
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 1:478 KY 11 N
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-9155
Mailing Address - Country:US
Mailing Address - Phone:606-593-0382
Mailing Address - Fax:
Practice Address - Street 1:478 KY 11 N
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314-9155
Practice Address - Country:US
Practice Address - Phone:606-593-0382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist