Active NPI
Candace Traylor-Holt, PHARMD
- Pharmacist
- Chicago, IL
National Provider Identifier
1720683774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.293852
- Practice address
- 1211 W Roosevelt Rd
Chicago, IL 60608-1413 - Phone
- (312) 733-0147
- NPI assigned
- Nov 30, 2020
- Last updated
- Nov 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.293852 | IL | Primary |
Addresses
Primary practice location
1211 W Roosevelt Rd
Chicago, IL 60608-1413
Mailing address
1211 W Roosevelt Rd
Chicago, IL 60608-1413
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051.293852 | Other | IL | PHARMACY LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | CVS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.293852 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1720683774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 W ROOSEVELT RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 W ROOSEVELT RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081413",
"telephone_number": "312-733-0147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAYLOR-HOLT",
"first_name": "CANDACE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.293852",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "051.293852",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "CVS",
"affiliation": "N",
"address_1": "1211 W Roosevelt Rd",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606081413",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.