Provider Demographics
NPI:1972276996
Name:WILDE, TAYLOR ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ANN
Last Name:WILDE
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 1:4133 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4818
Mailing Address - Country:US
Mailing Address - Phone:307-299-4067
Mailing Address - Fax:
Practice Address - Street 1:205 E EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3909
Practice Address - Country:US
Practice Address - Phone:970-669-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist