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General NPI Number Information
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NPI Number | 1366735870
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Entity Type | Individual
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Provider Name | CONSTANCE JOYCE TAYLOR CONNIE TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 43 W PRAIRIE SHOPPING CTR
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City | HAYDEN
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State | ID
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Zip | 83835-9854
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Country | US
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Telephone | 208-772-5543
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Fax | 208-772-7176
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Provider Business Mailing Address
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Address Line | 3692 W FAIRWAY DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8020
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Country | US
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Telephone | 208-765-5323
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Fax | 208-772-7176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P3701
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00009309
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License Number State | WA
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