Provider Demographics
NPI:1871788836
Name:TAYLOR, MADELAINE KATRINA (PHARM D)
Entity type:Individual
Prefix:
First Name:MADELAINE
Middle Name:KATRINA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5432
Mailing Address - Country:US
Mailing Address - Phone:425-514-5010
Mailing Address - Fax:
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5432
Practice Address - Country:US
Practice Address - Phone:425-514-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006792183500000X
WAPH60188341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist