Healthcare Provider Details

I. General information

NPI: 1366965535
Provider Name (Legal Business Name): TAYLOR SANDVICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 BIGHORN RD
FORT COLLINS CO
80525-3480
US

IV. Provider business mailing address

2025 BIGHORN RD
FORT COLLINS CO
80525-3480
US

V. Phone/Fax

Practice location:
  • Phone: 970-229-9800
  • Fax: 970-229-1421
Mailing address:
  • Phone: 970-229-9800
  • Fax: 970-229-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39547
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA.0022545
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: