Provider Demographics
NPI:1447437629
Name:GUYTON, CANDACE YVETTE (RPH)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:YVETTE
Last Name:GUYTON
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 1:12525 LOCHLOOSA LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2344
Mailing Address - Country:US
Mailing Address - Phone:904-766-5210
Mailing Address - Fax:
Practice Address - Street 1:12525 LOCHLOOSA LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2344
Practice Address - Country:US
Practice Address - Phone:904-766-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS028702OtherPHARMACIST