Provider Demographics
NPI:1427331990
Name:MCCANDLISH, PAMELA JO (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:MCCANDLISH
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 1:1400 MEADOWS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3660
Mailing Address - Country:US
Mailing Address - Phone:740-475-4388
Mailing Address - Fax:
Practice Address - Street 1:1400 MEADOWS DRIVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3660
Practice Address - Country:US
Practice Address - Phone:740-475-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist