Provider Demographics
NPI:1841951993
Name:TAYLOR, JACINDA (PHARMD)
Entity type:Individual
Prefix:
First Name:JACINDA
Middle Name:
Last Name:TAYLOR
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 1:1641 GUS BLAZE RD
Mailing Address - Street 2:
Mailing Address - City:GALATA
Mailing Address - State:MT
Mailing Address - Zip Code:59444-9509
Mailing Address - Country:US
Mailing Address - Phone:406-460-0474
Mailing Address - Fax:
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-2823
Practice Address - Country:US
Practice Address - Phone:406-873-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9807183500000X
MT83265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist