Provider Demographics
NPI:1861476541
Name:SHAW, CANDACE J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:J
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:# 100
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-515-1881
Mailing Address - Fax:310-515-0951
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:# 100
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-515-1881
Practice Address - Fax:310-515-0951
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist