MEDICARE: TIFFANY DIANN TAYLOR PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26025678A	IN
2	183500000X	Pharmacist	19855	NV

General Provider Information

NPI Number	:	1245703610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DIANN TAYLOR PHARMD

Provider Business Mailing Address
First Line	:	1714 MONTAVO AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-0961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S VALLE VERDE DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-3433
Country	:	US
Telephone Number	:	702-837-6117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	01/08/2019

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