Provider Demographics
NPI:1649300021
Name:WALLS, CANDLER LINDSEY JR (RPH)
Entity type:Individual
Prefix:MR
First Name:CANDLER
Middle Name:LINDSEY
Last Name:WALLS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1128 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30119-0001
Mailing Address - Country:US
Mailing Address - Phone:770-836-0770
Mailing Address - Fax:770-836-7506
Practice Address - Street 1:1128 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30119-0001
Practice Address - Country:US
Practice Address - Phone:770-836-0770
Practice Address - Fax:770-836-7506
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist