MEDICARE: MARY JAY 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
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	42966	TX
2	1835P1200X	Pharmacotherapy Pharmacist	19435	MD
3	1835P1200X	Pharmacotherapy Pharmacist	42966	TX
4	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	19435	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699210096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JAY TAYLOR PHARMD

Provider Business Mailing Address
First Line	:	4861 ATLAS CEDAR WAY
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-5602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4861 ATLAS CEDAR WAY
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-5602
Country	:	US
Telephone Number	:	832-338-4869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	06/12/2017

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