Provider Demographics
NPI:1588265649
Name:HAUGTVEDT, CANDACE LOUISE (RPH, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:LOUISE
Last Name:HAUGTVEDT
Suffix:
Gender:F
Credentials:RPH, MS, PHD
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:LOUISE
Other - Last Name:WENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, MS, PHD
Mailing Address - Street 1:321 HIGHWAY 10 W
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3046
Mailing Address - Country:US
Mailing Address - Phone:218-847-9248
Mailing Address - Fax:
Practice Address - Street 1:321 US-10 WEST
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501
Practice Address - Country:US
Practice Address - Phone:218-847-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4018183500000X
OH03317263183500000X
MO40992183500000X
MN119986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist