Provider Demographics
NPI:1013926971
Name:VANDECANDELAERE, DENNIS GERARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:GERARD
Last Name:VANDECANDELAERE
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 1:5103 KENSINGTON
Mailing Address - Street 2:
Mailing Address - City:DETRIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48224
Mailing Address - Country:US
Mailing Address - Phone:313-576-3762
Mailing Address - Fax:313-576-1105
Practice Address - Street 1:4646 JOHN R
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-576-3762
Practice Address - Fax:313-576-1105
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist