Provider Demographics
NPI:1861709826
Name:MCCANDLISH, RAYMOND DREW (RPH)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DREW
Last Name:MCCANDLISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3125
Mailing Address - Country:US
Mailing Address - Phone:318-686-6311
Mailing Address - Fax:318-686-3999
Practice Address - Street 1:9250 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3125
Practice Address - Country:US
Practice Address - Phone:318-686-6311
Practice Address - Fax:318-686-3999
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37147183500000X
LA10370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist