Provider Demographics
NPI:1184319402
Name:JARDING, TAYLOR DAVID
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DAVID
Last Name:JARDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MICHIGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9743
Mailing Address - Country:US
Mailing Address - Phone:541-347-9457
Mailing Address - Fax:541-347-4909
Practice Address - Street 1:44 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9743
Practice Address - Country:US
Practice Address - Phone:541-347-9457
Practice Address - Fax:541-347-4909
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0012578183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician