Active NPI
Taylor Mark Phillips
- Pharmacist
- Idaho Falls, ID
National Provider Identifier
1306707013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9771562
- Practice address
- 3100 Channing Way
Idaho Falls, ID 83404-7533 - Phone
- (208) 535-4769
- NPI assigned
- Nov 21, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9771562 | ID | Primary |
Addresses
Primary practice location
3100 Channing Way
Idaho Falls, ID 83404-7533
Mailing address
2746 Judy St Apt 3102
Ammon, ID 83406-5244
Phone (208) 506-0050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9771562 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763683200000",
"number": "1306707013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2746 JUDY ST APT 3102",
"city": "AMMON",
"state": "ID",
"postal_code": "834065244",
"telephone_number": "208-506-0050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 CHANNING WAY",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047533",
"telephone_number": "208-535-4769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "TAYLOR",
"middle_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-11-21",
"last_updated": "2025-11-21",
"certification_date": "2025-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "9771562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.