Provider Demographics
NPI:1932521465
Name:TAYLOR, AMANDA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
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 1:4617 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2305
Mailing Address - Country:US
Mailing Address - Phone:602-482-5511
Mailing Address - Fax:602-482-7603
Practice Address - Street 1:4617 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2305
Practice Address - Country:US
Practice Address - Phone:602-482-5511
Practice Address - Fax:602-482-7603
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist