Basic Information
| Provider Information | |||||||||
| NPI: | 1548819519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOOFT | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | JONES | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 E STATE HIGHWAY 55 APT 310 | ||||||||
| Address2: | |||||||||
| City: | PAYNESVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563622074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078288854 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1027 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565013409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188475611 | ||||||||
| FaxNumber: | 2188442444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2019 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | 124422 | MN | Y |
No ID Information.