Provider Demographics
NPI:1962172403
Name:FLETCHER, CANDACE DAWN (PHARMD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:DAWN
Last Name:FLETCHER
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 1:11610 VISTA TERRACE WAY APT 2304
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2875
Mailing Address - Country:US
Mailing Address - Phone:276-312-0810
Mailing Address - Fax:
Practice Address - Street 1:220 FOOTHILLS MALL DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5516
Practice Address - Country:US
Practice Address - Phone:865-379-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000045561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45561OtherTENNESSEE PHARMACIST LICENSE NUMBER