Individual
JASON IVORY TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3333 E.SHELBY DR., MEMPHIS, TN 38105-4510
(901) 794-3690
Mailing address
568 POPLAR AVE, MEMPHIS, TN 38105-4510
(901) 527-2411
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
0000014700
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4442531
—
TN
Enumeration date
11/03/2011
Last updated
11/03/2011
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