Provider Demographics
NPI:1811208911
Name:KENNEDY, CANDACE KRISTAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:KRISTAN
Last Name:KENNEDY
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 1:104 W 5TH AVE
Mailing Address - Street 2:STE 190 EAST
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-474-2232
Mailing Address - Fax:
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:STE 190 EAST
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-474-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist