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 1:921 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2213
Mailing Address - Country:US
Mailing Address - Phone:406-460-0474
Mailing Address - Fax:
Practice Address - Street 1:622 E USTICK RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6311
Practice Address - Country:US
Practice Address - Phone:208-453-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT83265183500000X
IDP9807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist