Provider Demographics
NPI:1023283991
Name:CANDELARIA, MARY ANNABEL (RPH,MBA,PHARMD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNABEL
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:RPH,MBA,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WALTER ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3556
Mailing Address - Country:US
Mailing Address - Phone:505-250-2800
Mailing Address - Fax:
Practice Address - Street 1:2100 CARLISLE BLVD NE
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3810
Practice Address - Country:US
Practice Address - Phone:505-265-3549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000054741835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist