Provider Demographics
NPI:1174216402
Name:MCCANLESS, JASON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MCCANLESS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 ELK RUN RD
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-9006
Mailing Address - Country:US
Mailing Address - Phone:970-210-6801
Mailing Address - Fax:
Practice Address - Street 1:975 ELK RUN RD
Practice Address - Street 2:
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498-9006
Practice Address - Country:US
Practice Address - Phone:970-210-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH33536183500000X
COPH33536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist