Provider Demographics
NPI:1942990296
Name:MCCANDLESS, MARIAN CAROL
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:CAROL
Last Name:MCCANDLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9818 354TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9313
Mailing Address - Country:US
Mailing Address - Phone:425-281-0022
Mailing Address - Fax:
Practice Address - Street 1:5700 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8914
Practice Address - Country:US
Practice Address - Phone:425-391-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30175918183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician