Provider Demographics
NPI:1063008878
Name:TAYLOR, DANIELLE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 N SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6208
Mailing Address - Country:US
Mailing Address - Phone:520-249-3273
Mailing Address - Fax:
Practice Address - Street 1:85 S HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3637
Practice Address - Country:US
Practice Address - Phone:520-439-6081
Practice Address - Fax:520-439-6083
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS12387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist