Provider Demographics
NPI:1952992828
Name:VASILYEV, CANDACE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:VASILYEV
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3826 MAJESTIC OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8143
Mailing Address - Country:US
Mailing Address - Phone:662-832-8321
Mailing Address - Fax:
Practice Address - Street 1:501 BRAMLETT BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4129
Practice Address - Country:US
Practice Address - Phone:662-234-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-096713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy