Healthcare Provider Details

I. General information

NPI: 1629438882
Provider Name (Legal Business Name): TAYLOR NICHOLS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

IV. Provider business mailing address

1800 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

V. Phone/Fax

Practice location:
  • Phone: 602-251-8818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS020922
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number4150033
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: