Provider Demographics
NPI:1285796227
Name:STILLEY, CANDIDA REGISTER (RPH)
Entity type:Individual
Prefix:MRS
First Name:CANDIDA
Middle Name:REGISTER
Last Name:STILLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 NC HIGHWAY 55 W
Mailing Address - Street 2:
Mailing Address - City:COVE CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28523-9448
Mailing Address - Country:US
Mailing Address - Phone:252-636-1711
Mailing Address - Fax:252-636-2615
Practice Address - Street 1:2117 S GLENBURNIE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2239
Practice Address - Country:US
Practice Address - Phone:252-636-1711
Practice Address - Fax:252-636-2615
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15466OtherNC BOARD OF PHARMACY LIC.