Provider Demographics
NPI:1366615080
Name:MADERY, KANDIDA DE LA CRUZ (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KANDIDA
Middle Name:DE LA CRUZ
Last Name:MADERY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:KANDIDA
Other - Middle Name:LENZ
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-0069
Mailing Address - Country:US
Mailing Address - Phone:530-680-0308
Mailing Address - Fax:
Practice Address - Street 1:5125 SKYWAY
Practice Address - Street 2:SUITE F
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5624
Practice Address - Country:US
Practice Address - Phone:530-680-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59493183500000X
FLPS41571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist