Provider Demographics
NPI:1649872672
Name:TAYLOR, JASON LEE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E BRIGGS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1906
Mailing Address - Country:US
Mailing Address - Phone:660-385-5794
Mailing Address - Fax:
Practice Address - Street 1:705 E BRIGGS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1906
Practice Address - Country:US
Practice Address - Phone:660-385-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist