Provider Demographics
NPI:1295321396
Name:COMPTON, CANDIUS JEANNE
Entity type:Individual
Prefix:
First Name:CANDIUS
Middle Name:JEANNE
Last Name:COMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDIUS
Other - Middle Name:JEANNE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1370 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1895
Mailing Address - Country:US
Mailing Address - Phone:740-344-6977
Mailing Address - Fax:740-344-5593
Practice Address - Street 1:1370 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1895
Practice Address - Country:US
Practice Address - Phone:740-344-6977
Practice Address - Fax:740-344-5593
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09206429183700000X
OH09206429183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician