Provider Demographics
NPI:1528792108
Name:TAYLOR, JEFFREY SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33472 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:GLADE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24340-5100
Mailing Address - Country:US
Mailing Address - Phone:276-429-2004
Mailing Address - Fax:276-429-2009
Practice Address - Street 1:33472 LEE HWY
Practice Address - Street 2:
Practice Address - City:GLADE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24340-5100
Practice Address - Country:US
Practice Address - Phone:276-429-2004
Practice Address - Fax:276-429-2009
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist