Provider Demographics
NPI:1023697141
Name:CANIDA, LYLE (PHARMD, MS, CPH)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:
Last Name:CANIDA
Suffix:
Gender:M
Credentials:PHARMD, MS, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ORANGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7505
Mailing Address - Country:US
Mailing Address - Phone:410-514-6090
Mailing Address - Fax:
Practice Address - Street 1:1118 ORANGEWOOD DR
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7505
Practice Address - Country:US
Practice Address - Phone:410-514-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS46562OtherPHARMACIST LICENSE