Provider Demographics
NPI:1902564313
Name:TAYLOR, JILLIAN BROOKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:BROOKE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-7543
Mailing Address - Country:US
Mailing Address - Phone:912-288-1898
Mailing Address - Fax:912-496-3329
Practice Address - Street 1:3885 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-7543
Practice Address - Country:US
Practice Address - Phone:912-496-2044
Practice Address - Fax:912-496-3329
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist