=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922614619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAYLOR SEGOVIA RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2020
-----------------------------------------------------
Last Update Date | 09/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2401 W 21ST ST
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88101-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-769-7541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136 CREST POINT DR
-----------------------------------------------------
City | PORTALES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88130-9057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-309-9816
-----------------------------------------------------
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 | RP00009139
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------