Provider Demographics
NPI:1124421730
Name:BINTRIM, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BINTRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 BAYSIDE RD
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3112
Mailing Address - Country:US
Mailing Address - Phone:410-257-2050
Mailing Address - Fax:
Practice Address - Street 1:7955 BAYSIDE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3112
Practice Address - Country:US
Practice Address - Phone:410-257-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist