Provider Demographics
NPI:1689127227
Name:LACROSS, TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:LACROSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N DEARBORN ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2226
Mailing Address - Country:US
Mailing Address - Phone:317-840-7953
Mailing Address - Fax:
Practice Address - Street 1:641 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3796
Practice Address - Country:US
Practice Address - Phone:312-587-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist