Healthcare Provider Details

I. General information

NPI: 1699210096
Provider Name (Legal Business Name): MARY JAY TAYLOR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 ATLAS CEDAR WAY
ABERDEEN MD
21001-5602
US

IV. Provider business mailing address

4861 ATLAS CEDAR WAY
ABERDEEN MD
21001-5602
US

V. Phone/Fax

Practice location:
  • Phone: 832-338-4869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number19435
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number42966
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number42966
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19435
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: