Basic Information
| Provider Information | |||||||||
| NPI: | 1366965535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDVICK | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 BIGHORN RD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805253480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702299800 | ||||||||
| FaxNumber: | 9702291421 | ||||||||
| Practice Location | |||||||||
| Address1: | 2025 BIGHORN RD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805253480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702299800 | ||||||||
| FaxNumber: | 9702291421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 39547 | MT | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | PHA.0022545 | CO | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.