MEDICARE: MRS. JEANNIE LYNN TAYLOR RPH

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	5302028613	MI

General Provider Information

NPI Number	:	1881643351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNIE LYNN TAYLOR RPH

Provider Business Mailing Address
First Line	:	36086 SAINT CLAIR DR
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-5526
Country	:	US
Telephone Number	:	586-322-6985
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N RIVERSIDE AVE
Second Line	:	A-1
City	:	ST CLAIR
State	:	MI
Zip	:	48079-5491
Country	:	US
Telephone Number	:	810-326-1233
Fax Number	:	810-326-2901

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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