Healthcare Provider Details

I. General information

NPI: 1255095618
Provider Name (Legal Business Name): TAYLOR YOUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 03/17/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10565 W LAKE HAZEL RD
BOISE ID
83709-6326
US

IV. Provider business mailing address

1650 W STATE ST
BOISE ID
83702-4040
US

V. Phone/Fax

Practice location:
  • Phone: 208-319-0882
  • Fax: 208-319-0882
Mailing address:
  • Phone: 208-344-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP9766
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: