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NPI Code Detail

MEDICARE: JESSICA LYNN TAYLOR PHARMD

MEDICARE: JESSICA LYNN TAYLOR PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051296657IL

General Provider Information

NPI Number : 1184225492
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN TAYLOR PHARMD
Provider Business Mailing Address
First Line : 20400 STATE HIGHWAY 16
Second Line :
City : ASHMORE
State : IL
Zip : 61912-9142
Country : US
Telephone Number : 217-276-5612
Fax Number :
Provider Business Practice Location Address
First Line : 2250 LINCOLN AVE
Second Line :
City : CHARLESTON
State : IL
Zip : 61920-3028
Country : US
Telephone Number : 217-345-9458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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