Provider Demographics
NPI:1922394659
Name:KANDZER, PAUL LAWRENCE (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LAWRENCE
Last Name:KANDZER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GRANT HILL LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5064
Mailing Address - Country:US
Mailing Address - Phone:336-245-0471
Mailing Address - Fax:336-245-0478
Practice Address - Street 1:150 GRANT HILL LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-5064
Practice Address - Country:US
Practice Address - Phone:336-245-0471
Practice Address - Fax:336-245-0478
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist