Provider Demographics
NPI:1801267463
Name:TAYLOR, JENNIFER H
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2449
Mailing Address - Country:US
Mailing Address - Phone:804-639-5719
Mailing Address - Fax:
Practice Address - Street 1:14501 HANCOCK VILLAGE ST
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2776
Practice Address - Country:US
Practice Address - Phone:804-739-1668
Practice Address - Fax:804-739-4652
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist