Provider Demographics
NPI:1598073082
Name:TAYLOR, JODI L (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3316
Mailing Address - Country:US
Mailing Address - Phone:731-693-1494
Mailing Address - Fax:
Practice Address - Street 1:1050 UNION UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3656
Practice Address - Country:US
Practice Address - Phone:731-661-5922
Practice Address - Fax:731-661-5980
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist