Provider Demographics
NPI:1669171377
Name:MCCANN, KAYLA (PHARMD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MCCANN
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-0204
Mailing Address - Country:US
Mailing Address - Phone:530-200-0580
Mailing Address - Fax:
Practice Address - Street 1:9850 KENT ST
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9483
Practice Address - Country:US
Practice Address - Phone:530-200-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist