Provider Demographics
NPI:1407283708
Name:TAYLOR, JACOB JOHN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:JOHN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 LARKIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2600
Mailing Address - Country:US
Mailing Address - Phone:209-541-9831
Mailing Address - Fax:
Practice Address - Street 1:133 15TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2746
Practice Address - Country:US
Practice Address - Phone:831-373-1225
Practice Address - Fax:831-373-3705
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist