=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801267463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER H TAYLOR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 10/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14501 HANCOCK VILLAGE ST
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-739-1668
-----------------------------------------------------
Fax | 804-739-4652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8701 TORREY PINES DR
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-639-5719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202012488
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------