Provider Demographics
NPI:1922603521
Name:FAULKNER, CANDI (RPH, BS PHARM)
Entity Type:Individual
Prefix:
First Name:CANDI
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:RPH, BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2021
Mailing Address - Country:US
Mailing Address - Phone:816-842-2514
Mailing Address - Fax:
Practice Address - Street 1:921 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-2021
Practice Address - Country:US
Practice Address - Phone:816-842-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0439601835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care