Healthcare Provider Details

I. General information

NPI: 1417438490
Provider Name (Legal Business Name): KAYLI LYNN MCCANN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLI LYNN BUECHLER PHARMD

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 1ST ST S
WILLMAR MN
56201-4209
US

IV. Provider business mailing address

2201 1ST ST S
WILLMAR MN
56201-4368
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-8502
  • Fax:
Mailing address:
  • Phone: 320-214-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number123541
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: