Provider Demographics
NPI:1336548742
Name:JONES, CANDACE DIXON (CPP)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:DIXON
Last Name:JONES
Suffix:
Gender:F
Credentials:CPP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MICHELLE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPP
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:919-749-2916
Mailing Address - Fax:
Practice Address - Street 1:10110 S 7650TH E
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:919-749-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24004183500000X
MTPHA-PHA-LIC-810131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist