Healthcare Provider Details

I. General information

NPI: 1558875765
Provider Name (Legal Business Name): SHERYL LYNN CANLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

IV. Provider business mailing address

5641 SHERIFF RD
CAPITOL HGTS MD
20743
US

V. Phone/Fax

Practice location:
  • Phone: 202-346-3009
  • Fax: 202-346-3302
Mailing address:
  • Phone: 202-679-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number25316
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPHI100003068
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: