Provider Demographics
NPI:1386383958
Name:VO, KANDACE (PHARMD)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:
Last Name:VO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13407 INDIANA AVE APT 1702
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1867
Mailing Address - Country:US
Mailing Address - Phone:469-323-1612
Mailing Address - Fax:
Practice Address - Street 1:4205 98TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3971
Practice Address - Country:US
Practice Address - Phone:806-798-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist