Provider Demographics
NPI:1871902569
Name:MCCANN, SAGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAGE
Middle Name:
Last Name:MCCANN
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 1:125 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3672
Mailing Address - Country:US
Mailing Address - Phone:307-789-0020
Mailing Address - Fax:
Practice Address - Street 1:125 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3672
Practice Address - Country:US
Practice Address - Phone:307-789-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist