Provider Demographics
NPI:1861786121
Name:LEAVELL, CANDICE (PHARMD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:LEAVELL
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 1:714 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45203-1307
Mailing Address - Country:US
Mailing Address - Phone:513-337-9701
Mailing Address - Fax:
Practice Address - Street 1:160 PAVILLION PKWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2884
Practice Address - Country:US
Practice Address - Phone:859-814-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230657183500000X
KY015324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist