Provider Demographics
NPI:1790367050
Name:LANNING, TAYLOR (CPHT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LANNING
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 MARYSVILLE MALL
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5501
Mailing Address - Country:US
Mailing Address - Phone:360-659-0492
Mailing Address - Fax:360-658-0588
Practice Address - Street 1:251 MARYSVILLE MALL
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5501
Practice Address - Country:US
Practice Address - Phone:360-659-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60562853183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician