Provider Demographics
NPI:1225847643
Name:AVIVA NORTHWEST, PLLC
Entity type:Organization
Organization Name:AVIVA NORTHWEST, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:509-385-1290
Mailing Address - Street 1:301 N 1ST ST APT 416
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2845
Mailing Address - Country:US
Mailing Address - Phone:509-868-6023
Mailing Address - Fax:509-231-7045
Practice Address - Street 1:301 N 1ST ST APT 416
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2845
Practice Address - Country:US
Practice Address - Phone:509-688-6023
Practice Address - Fax:509-231-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty