Basic Information
| Provider Information | |||||||||
| NPI: | 1013926971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDECANDELAERE | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5103 KENSINGTON | ||||||||
| Address2: | |||||||||
| City: | DETRIOT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135763762 | ||||||||
| FaxNumber: | 3135761105 | ||||||||
| Practice Location | |||||||||
| Address1: | 4646 JOHN R | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135763762 | ||||||||
| FaxNumber: | 3135761105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302025771 | MI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.