Healthcare Provider Details

I. General information

NPI: 1841951993
Provider Name (Legal Business Name): JACINDA TAYLOR PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E USTICK RD
CALDWELL ID
83605-6311
US

IV. Provider business mailing address

921 W 2ND ST
MERIDIAN ID
83642-2213
US

V. Phone/Fax

Practice location:
  • Phone: 208-453-2852
  • Fax:
Mailing address:
  • Phone: 406-460-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83265
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP9807
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: