Provider Demographics
NPI:1013443803
Name:TAYLOR, KIERSTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIERSTEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KIERSTEN
Other - Middle Name:TAYLOR
Other - Last Name:ATTAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9808 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-3206
Mailing Address - Country:US
Mailing Address - Phone:323-779-9963
Mailing Address - Fax:
Practice Address - Street 1:4211 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5622
Practice Address - Country:US
Practice Address - Phone:323-233-0425
Practice Address - Fax:323-233-5015
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62288183500000X
CA107671835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacist