Provider Demographics
NPI:1730177833
Name:TAYLOR, JENNIFER ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
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 1:301 N 1ST ST APT 416
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2845
Mailing Address - Country:US
Mailing Address - Phone:509-385-1290
Mailing Address - Fax:
Practice Address - Street 1:16609 E DESMET CT APT B405
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3552
Practice Address - Country:US
Practice Address - Phone:509-385-1290
Practice Address - Fax:509-385-1290
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020470183500000X, 1835P0018X, 1835P1200X
IDP112501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy