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AVIVA NORTHWEST PLLC

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Company Details

Name: AVIVA NORTHWEST PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 10 Apr 2025 (2 months ago)
Financial Date End: 30 Apr 2026
Entity Number: 5685349
Place of Formation: IDAHO
File Number: 930866
ZIP code: 83814
County: Kootenai County
Principal Address: APT 416 301 N 1ST ST COEUR D ALENE, ID 83814
Mailing Address: APT 416 301 N 1ST ST COEUR D ALENE, ID 83814-2845

Agent

Name Role Address
SHAWN TAYLOR Agent 301 N 1ST ST, APT 416, COEUR D ALENE, ID 83814

National Provider Identifier

NPI Number:
1225847643
Certification Date:
2025-04-19

Authorized Person:

Name:
DR. JENNIFER TAYLOR
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1835P0018X - Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Is Primary:
Yes

Contacts:

Fax:
5092317045

Filing

Filing Name Filing Number Filing date
Statement of Domestication In 0006203517 2025-04-10
Initial Filing 0005685349 2024-04-09

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Date of last update: 22 May 2025

Sources: Idaho Secretary of State